Provider Demographics
NPI:1457766453
Name:ORTIZ, MARIO
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N GREEN VALLEY PKWY STE 260
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7100
Mailing Address - Country:US
Mailing Address - Phone:562-556-7388
Mailing Address - Fax:
Practice Address - Street 1:1401 N GREEN VALLEY PKWY STE 260
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7100
Practice Address - Country:US
Practice Address - Phone:562-556-7388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116555106H00000X
CAIMF79458106H00000X
NV3293-R106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist