Provider Demographics
NPI:1568079754
Name:ORTIZ-MARMOLEJO, AILENE
Entity type:Individual
Prefix:
First Name:AILENE
Middle Name:
Last Name:ORTIZ-MARMOLEJO
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 1:1801 PARK COURT PL BLDG H
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5028
Mailing Address - Country:US
Mailing Address - Phone:714-957-1004
Mailing Address - Fax:714-550-9658
Practice Address - Street 1:1801 PARK COURT PL BLDG H
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5028
Practice Address - Country:US
Practice Address - Phone:714-957-1004
Practice Address - Fax:714-550-9658
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1239481041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical