Healthcare Provider Details

I. General information

NPI: 1780243956
Provider Name (Legal Business Name): ELIZABETH ORTIZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 WEST AVE STE 301
LUDLOW MA
01056-1739
US

IV. Provider business mailing address

185 WEST AVE STE 301
LUDLOW MA
01056-1739
US

V. Phone/Fax

Practice location:
  • Phone: 413-583-6750
  • Fax:
Mailing address:
  • Phone: 413-583-6750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: