Healthcare Provider Details

I. General information

NPI: 1043334360
Provider Name (Legal Business Name): ELIZABETH ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 06/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 LOS LENTES
LOS LUNAS NM
87031
US

IV. Provider business mailing address

428 LOS LENTES
LOS LUNAS NM
87031
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-3350
  • Fax:
Mailing address:
  • Phone: 505-865-3350
  • Fax: 505-865-4739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: