Provider Demographics
NPI:1346769940
Name:ELORTONDO, LUIS (PA-C)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:ELORTONDO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 ASPENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-8759
Mailing Address - Country:US
Mailing Address - Phone:720-335-5644
Mailing Address - Fax:
Practice Address - Street 1:1508 ASPENWOOD LN
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-8759
Practice Address - Country:US
Practice Address - Phone:720-335-5644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0006432363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant