Provider Demographics
NPI:1417140856
Name:BETTY ELIZABETH ORTIZ
Entity Type:Organization
Organization Name:BETTY ELIZABETH ORTIZ
Other - Org Name:CASA BENDITA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:PROVIDER
Authorized Official - Phone:956-753-9205
Mailing Address - Street 1:129 PALENCIA AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-8524
Mailing Address - Country:US
Mailing Address - Phone:956-753-9205
Mailing Address - Fax:
Practice Address - Street 1:129 PALENCIA AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-8524
Practice Address - Country:US
Practice Address - Phone:956-753-9205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120939251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120939Medicaid