Basic Information
| Provider Information | |||||||||
| NPI: | 1083226526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORTIZ | ||||||||
| FirstName: | YULISSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1191 | ||||||||
| Address2: | |||||||||
| City: | PAUMA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920611191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7605329690 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1160 S GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917405000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263355980 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2020 | ||||||||
| LastUpdateDate: | 09/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 101YP2500X | APCC12214 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.