Provider Demographics
NPI:1548383185
Name:ORTIZ, CARLOS (CM)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-2761
Mailing Address - Country:US
Mailing Address - Phone:954-567-7141
Mailing Address - Fax:954-703-2029
Practice Address - Street 1:830 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 121
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-2761
Practice Address - Country:US
Practice Address - Phone:954-567-7141
Practice Address - Fax:954-703-2029
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker