Provider Demographics
NPI:1538856281
Name:ORTEGA, CARLOS DANIEL
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:DANIEL
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16500 CAGAN OAKS APT 206
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-6592
Mailing Address - Country:US
Mailing Address - Phone:786-436-1291
Mailing Address - Fax:
Practice Address - Street 1:16500 CAGAN OAKS APT 206
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-6592
Practice Address - Country:US
Practice Address - Phone:786-436-1291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-257045106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician