Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013534056 |
---|---|
Provider Name | William Ortiz |
First Address | Burbank, CA 91505-3173 |
Second Address | Van Nuys, CA 91406-3345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2020 |
Last Update Date | 25/06/2020 |