Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 103G00000X | Clinical Psychologist | PSY32501 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY32501 | CA |
N | 225C00000X | Rehabilitation Counselor | RPS2012152 | CA |
NPI | 1134246036 |
---|---|
Provider Name | Dr. Tiffany Mella Ortiz |
First Address | Los Angeles, CA 90026 |
Second Address | Los Angeles, CA 90017-1833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 07/05/2021 |