Provider Demographics
NPI:1073565743
Name:OTEIZA, ELIZABETH (MD)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:
Last Name:OTEIZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17070 GULF PINE CIR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6351
Mailing Address - Country:US
Mailing Address - Phone:561-793-9097
Mailing Address - Fax:
Practice Address - Street 1:901 N CONGRESS AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3316
Practice Address - Country:US
Practice Address - Phone:561-732-8005
Practice Address - Fax:561-732-0150
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60379207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26156Medicare ID - Type Unspecified
FLF90350Medicare UPIN