Healthcare Provider Details

I. General information

NPI: 1861971079
Provider Name (Legal Business Name): JOSE NATHAN ORTIZ CADENA MAE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 E 4TH PLAIN BLVD
VANCOUVER WA
98661-3965
US

IV. Provider business mailing address

2502 E 4TH PLAIN BLVD
VANCOUVER WA
98661-3965
US

V. Phone/Fax

Practice location:
  • Phone: 304-831-0904
  • Fax:
Mailing address:
  • Phone: 304-831-0904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: