Provider Demographics
NPI:1346461464
Name:ODIOTT, BETZAIDA ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:BETZAIDA
Middle Name:ELIZABETH
Last Name:ODIOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETZAIDA
Other - Middle Name:E
Other - Last Name:ODIOTT SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:HC 1 BOX 3120
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-9712
Mailing Address - Country:US
Mailing Address - Phone:787-364-0503
Mailing Address - Fax:
Practice Address - Street 1:CALLE 65 INFANTERIA #37
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-264-9503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14733208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice