Healthcare Provider Details

I. General information

NPI: 1043077316
Provider Name (Legal Business Name): LARUE ELIZABETH ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 N MOTEL BLVD
LAS CRUCES NM
88007-4169
US

IV. Provider business mailing address

590 LANWARD CT
EL PASO TX
79932-2727
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-4805
  • Fax:
Mailing address:
  • Phone: 915-328-7696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: