Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1013440379 |
---|---|
Provider Name | Mr. Luis Armando Ortiz JR. |
First Address | Riverside, CA 92501-3408 |
Second Address | Riverside, CA 92504-2037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2017 |
Last Update Date | 17/03/2018 |