Provider Demographics
NPI:1619451721
Name:ORTIZ, ELYSE M (ND)
Entity Type:Individual
Prefix:DR
First Name:ELYSE
Middle Name:M
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6745 SW SCHOLLS FERRY RD APT 18
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5498
Mailing Address - Country:US
Mailing Address - Phone:909-200-9532
Mailing Address - Fax:
Practice Address - Street 1:049 SW PORTER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-4878
Practice Address - Country:US
Practice Address - Phone:503-552-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath