Provider Demographics
NPI:1134744436
Name:ORTIZ, ANTOINETTE RENE (CMT)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:RENE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S SUNSET AVE SUITE 350
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-9179
Mailing Address - Country:US
Mailing Address - Phone:626-377-0753
Mailing Address - Fax:626-465-4694
Practice Address - Street 1:1363 N HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1600
Practice Address - Country:US
Practice Address - Phone:626-337-0753
Practice Address - Fax:626-465-4694
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77620225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist