1467604777 NPI number — ELIZABETH COVARRUBIAS MENDOZA CPNP

Table of content: ELIZABETH COVARRUBIAS MENDOZA CPNP (NPI 1467604777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467604777 NPI number — ELIZABETH COVARRUBIAS MENDOZA CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENDOZA
Provider First Name:
ELIZABETH
Provider Middle Name:
COVARRUBIAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COVARRUBIAS
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1467604777
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1570 LOMALAND DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79935-4224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-590-4555
Provider Business Mailing Address Fax Number:
915-590-4718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1570 LOMALAND DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79935-4224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-590-4555
Provider Business Practice Location Address Fax Number:
915-590-4718
Provider Enumeration Date:
10/17/2008

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: 363LP0200X , with the licence number:  707287 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: AP116888 , 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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