Provider Demographics
NPI:1366121022
Name:ORTIZ, SONJA ANGELICA
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:ANGELICA
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 1:856 CADENCE VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-1041
Mailing Address - Country:US
Mailing Address - Phone:702-482-3398
Mailing Address - Fax:
Practice Address - Street 1:5755 S RAINBOW BLVD # 89118
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2534
Practice Address - Country:US
Practice Address - Phone:321-443-9191
Practice Address - Fax:725-205-2904
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-3568106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty