Provider Demographics
NPI:1962081687
Name:ORTIZ, TANIA (MS)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30221 SETTERFELD CIR
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78015-2101
Mailing Address - Country:US
Mailing Address - Phone:909-732-3682
Mailing Address - Fax:
Practice Address - Street 1:21015 MARKET RDG STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4979
Practice Address - Country:US
Practice Address - Phone:210-496-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health