Healthcare Provider Details

I. General information

NPI: 1508314915
Provider Name (Legal Business Name): CARLOS RAMOS ORTOLAZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7617 MINERAL POINT RD STE 300
MADISON WI
53717-1623
US

IV. Provider business mailing address

7617 MINERAL POINT RD STE 300
MADISON WI
53717-1623
US

V. Phone/Fax

Practice location:
  • Phone: 608-833-9290
  • Fax:
Mailing address:
  • Phone: 608-833-9290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8091-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: