Provider Demographics
NPI:1528677093
Name:ORTIZ, CRISTIE LYNN
Entity type:Individual
Prefix:
First Name:CRISTIE
Middle Name:LYNN
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 1:1110 PENNSYLVANIA ST NE SUITE B
Mailing Address - Street 2:PAIN AND RECOVERY CENTER
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110
Mailing Address - Country:US
Mailing Address - Phone:505-750-2034
Mailing Address - Fax:
Practice Address - Street 1:1110 PENNSYLVANIA ST NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7404
Practice Address - Country:US
Practice Address - Phone:505-750-2034
Practice Address - Fax:505-400-3029
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor