Provider Demographics
NPI:1407467343
Name:ORTIZ, EMILY CLAIRE (MS, RDN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CLAIRE
Last Name:ORTIZ
Suffix:
Gender:
Credentials:MS, RDN
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:CLAIRE
Other - Last Name:PELHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1450 W KAIBAB LN LOT 190
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-6208
Mailing Address - Country:US
Mailing Address - Phone:928-221-6474
Mailing Address - Fax:
Practice Address - Street 1:1450 W KAIBAB LN LOT 190
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-6208
Practice Address - Country:US
Practice Address - Phone:928-221-6474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86115601133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered