Provider Demographics
NPI:1922831577
Name:ORTIZ, MARCELLA
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARCELLA
Other - Middle Name:GRACE
Other - Last Name:BRASWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 CASSIA ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-2011
Mailing Address - Country:US
Mailing Address - Phone:650-683-0882
Mailing Address - Fax:
Practice Address - Street 1:1692 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-5208
Practice Address - Country:US
Practice Address - Phone:650-683-0882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker