1326631607 NPI number — JOCELYN ELIZONDO DDS

Table of content: JOCELYN ELIZONDO DDS (NPI 1326631607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326631607 NPI number — JOCELYN ELIZONDO DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELIZONDO
Provider First Name:
JOCELYN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1326631607
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
641 E SAN YSIDRO BLVD STE B3507
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN YSIDRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92173-3129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-210-4712
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLVD GRAL SANCHEZ TABOADA 9250
Provider Second Line Business Practice Location Address:
ZONA RIO LOCAL 26
Provider Business Practice Location Address City Name:
TIJUANA
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
22010
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
664-977-6267
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2021

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: 1223G0001X , with the licence number:  9459125 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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