Provider Demographics
NPI:1497726004
Name:ORTIZ GOVEO, ELSIE M (MD)
Entity Type:Individual
Prefix:DR
First Name:ELSIE
Middle Name:M
Last Name:ORTIZ GOVEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELSIE
Other - Middle Name:M
Other - Last Name:ORTIZ GOVEO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:COND VILLAS DE PARKVILLE
Mailing Address - Street 2:APT 235
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4501
Mailing Address - Country:US
Mailing Address - Phone:787-884-3980
Mailing Address - Fax:787-884-4479
Practice Address - Street 1:URB SAN SALVADOR E 1
Practice Address - Street 2:FERNANDEZ VANGA SUITE 2
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-3980
Practice Address - Fax:787-884-4479
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13054207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH82240Medicare UPIN