Healthcare Provider Details

I. General information

NPI: 1073565743
Provider Name (Legal Business Name): ELIZABETH OTEIZA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SE MONTEREY RD STE 104
STUART FL
34994-4512
US

IV. Provider business mailing address

PO BOX 947665
ATLANTA GA
30394-7665
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-2020
  • Fax: 772-219-7924
Mailing address:
  • Phone: 772-283-2020
  • Fax: 772-219-7924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME60379
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: