| Henry Ortiz Psyd | |
|
289 Dockside Ln San Pedro CA 90731-7400 | |
| (310) 776-2667 | |
| Not Available |
| Full Name | Henry Ortiz Psyd |
|---|---|
| Speciality | Psychologist |
| Location | 289 Dockside Ln, San Pedro, California |
| Authorized Official Name and Position | Henry J Ortiz (OWNER) |
| Authorized Official Contact | 3107762667 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Henry Ortiz Psyd 289 Dockside Ln San Pedro CA 90731-7400 Ph: (310) 776-2667 | Henry Ortiz Psyd 289 Dockside Ln San Pedro CA 90731-7400 Ph: (310) 776-2667 |
| NPI Number | 1942844311 |
|---|---|
| Provider Enumeration Date | 10/29/2019 |
| Last Update Date | 12/22/2022 |
| Certification Date | 12/22/2022 |
| Medicare PECOS PAC ID | 1658705793 |
|---|---|
| Medicare Enrollment ID | O20191226002064 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942844311 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Henry J Ortiz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538303094 PECOS PAC ID: 9638340110 Enrollment ID: I20110913000481 |
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