Provider Demographics
NPI:1609384643
Name:ORTIZ, HEATHER
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112107
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-2107
Mailing Address - Country:US
Mailing Address - Phone:907-887-9983
Mailing Address - Fax:844-561-6911
Practice Address - Street 1:13212 ELMHURST DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-4018
Practice Address - Country:US
Practice Address - Phone:907-887-9983
Practice Address - Fax:844-561-6911
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1682253171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator