Active NPI
Henry James Ortiz, PSY.D.
- Clinical Psychologist
- San Pedro, CA
National Provider Identifier
1538303094
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY19605
- Practice address
- 289 Dockside LN
San Pedro, CA 90731-7400 - Phone
- (310) 776-2667
- Fax
- (310) 929-7811
- NPI assigned
- Apr 28, 2009
- Last updated
- Dec 22, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY19605 | CA | Primary |
Addresses
Primary practice location
289 Dockside LN
San Pedro, CA 90731-7400
Mailing address
289 Dockside LN
San Pedro, CA 90731-7400
Phone (310) 776-2667
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2025 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY19605 | CA | MD | Clinical Psychologist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671667200000",
"number": "1538303094",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "289 DOCKSIDE LN",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907317400",
"telephone_number": "310-776-2667",
"fax_number": "310-929-7811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "289 DOCKSIDE LN",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907317400",
"telephone_number": "310-776-2667",
"fax_number": "310-929-7811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ORTIZ",
"first_name": "HENRY",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-04-28",
"last_updated": "2022-12-22",
"certification_date": "2022-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY19605",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Pedro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.