Provider Demographics
NPI:1043077316
Name:ORTIZ, LARUE ELIZABETH
Entity type:Individual
Prefix:
First Name:LARUE
Middle Name:ELIZABETH
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 ACADEMY RD NE APT 823
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7251
Mailing Address - Country:US
Mailing Address - Phone:915-328-7696
Mailing Address - Fax:
Practice Address - Street 1:901 RIO GRANDE BLVD NW STE H160
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-2063
Practice Address - Country:US
Practice Address - Phone:505-278-0807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program