Healthcare Provider Details

I. General information

NPI: 1811007149
Provider Name (Legal Business Name): ELIZABETH ANN BELITZ P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN SHERIDAN P.A.

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 UNSER BLVD SE
ALBUQUERQUE NM
87124-4740
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-720-6353
  • Fax:
Mailing address:
  • Phone: 505-923-6770
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2006-0016
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: