Provider Demographics
NPI:1124799796
Name:ORTEZ, JOHANNA ELENA (APCC)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:ELENA
Last Name:ORTEZ
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1001
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-1001
Mailing Address - Country:US
Mailing Address - Phone:909-685-7903
Mailing Address - Fax:
Practice Address - Street 1:9685 HAYES ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3660
Practice Address - Country:US
Practice Address - Phone:951-351-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health