Provider Demographics
NPI:1881953008
Name:ORTIZLUIS, ELIZA TINIO (LVN)
Entity type:Individual
Prefix:MISS
First Name:ELIZA
Middle Name:TINIO
Last Name:ORTIZLUIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6256 SAN RAMON WAY
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2840
Mailing Address - Country:US
Mailing Address - Phone:949-698-4904
Mailing Address - Fax:949-698-4904
Practice Address - Street 1:6256 SAN RAMON WAY
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-2840
Practice Address - Country:US
Practice Address - Phone:949-698-4904
Practice Address - Fax:949-698-4904
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN213834164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA3651966OtherA3651966