Provider Demographics
NPI:1164314241
Name:ORTIZ, EVELYN G
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:G
Last Name: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 1:824 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2609
Mailing Address - Country:US
Mailing Address - Phone:559-686-8751
Mailing Address - Fax:
Practice Address - Street 1:426 N BLACKSTONE ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4449
Practice Address - Country:US
Practice Address - Phone:559-688-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
CA1318B34F1171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool