Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 4391 | CA |
NPI | 1053485839 |
---|---|
Provider Name | Mrs. Cynthia Mercedes Ortiz |
First Address | Sacramento, CA 95835-1501 |
Second Address | Woodland, CA 95695-2510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |