Provider Demographics
NPI:1215081799
Name:ORTIZ, MILDRED (PSYD)
Entity type:Individual
Prefix:DR
First Name:MILDRED
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MILDRED
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:18000 STUDEBAKER RD STE 700
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2684
Mailing Address - Country:US
Mailing Address - Phone:310-864-0516
Mailing Address - Fax:323-364-5676
Practice Address - Street 1:18000 STUDEBAKER RD STE 700
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2684
Practice Address - Country:US
Practice Address - Phone:310-864-0516
Practice Address - Fax:323-364-5676
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TF0000X, 101YM0800X, 103TC2200X
CAPSY28287103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent