1568283240 NPI number — CARMEN ORTIZ CADC-I, CRM-II

Table of content: CARMEN ORTIZ CADC-I, CRM-II (NPI 1568283240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568283240 NPI number — CARMEN ORTIZ CADC-I, CRM-II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTIZ
Provider First Name:
CARMEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CADC-I, CRM-II
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568283240
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3800 SW CEDAR HILLS BLVD
Provider Second Line Business Mailing Address:
STE 170
Provider Business Mailing Address City Name:
BEAVERTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-626-1800
Provider Business Mailing Address Fax Number:
503-200-1192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 SW CEDAR HILLS BLVD
Provider Second Line Business Practice Location Address:
STE 170
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-626-1800
Provider Business Practice Location Address Fax Number:
503-200-1192
Provider Enumeration Date:
10/24/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 175T00000X , with the licence number:  25-CRM-II-0503 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 26-01-11748 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25-CRM-II-0503 . This is a "MHACBO-CRM" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 26-01-11748 . This is a "MHACBO-CADC" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".