Provider Demographics
NPI:1154551158
Name:ORTIGO, RICHARD EUGENE (PSYD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EUGENE
Last Name:ORTIGO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N KENWOOD ST UNIT 101
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-2372
Mailing Address - Country:US
Mailing Address - Phone:818-545-8561
Mailing Address - Fax:909-612-0602
Practice Address - Street 1:21660 COPLEY DR STE 350
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-5508
Practice Address - Country:US
Practice Address - Phone:909-612-0601
Practice Address - Fax:909-612-0602
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10692103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical