Provider Demographics
NPI:1154009090
Name:MARISCAL ORTIZ, LUZ PATRICIA
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:PATRICIA
Last Name:MARISCAL ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11038 HIGHLAND BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3789
Mailing Address - Country:US
Mailing Address - Phone:801-477-4403
Mailing Address - Fax:
Practice Address - Street 1:11038 HIGHLAND BLVD STE 400
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-3789
Practice Address - Country:US
Practice Address - Phone:801-477-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13425678-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist