1306834825 NPI number — DR. ELIZANDA MONICA DE LA SOTA PH.D.

Table of content: DR. ELIZANDA MONICA DE LA SOTA PH.D. (NPI 1306834825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306834825 NPI number — DR. ELIZANDA MONICA DE LA SOTA PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE LA SOTA
Provider First Name:
ELIZANDA
Provider Middle Name:
MONICA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306834825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6112 OLIVER LOVING TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78749-1834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-329-0989
Provider Business Mailing Address Fax Number:
512-329-0231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 S. MOPAC EXPWY.
Provider Second Line Business Practice Location Address:
BARTON OAKS ONE, SUITE 480
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-5787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-329-0989
Provider Business Practice Location Address Fax Number:
512-329-0231
Provider Enumeration Date:
10/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  23504 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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