1508919341 NPI number — DR. TEODORA BALQUIEDRA ELIZAGA M.D.

Table of content: DR. TEODORA BALQUIEDRA ELIZAGA M.D. (NPI 1508919341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508919341 NPI number — DR. TEODORA BALQUIEDRA ELIZAGA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELIZAGA
Provider First Name:
TEODORA
Provider Middle Name:
BALQUIEDRA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1508919341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1524 SUNSET BLVD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
STEUBENVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43952-1380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-282-5349
Provider Business Mailing Address Fax Number:
740-282-5340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1524 SUNSET BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
STEUBENVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43952-1380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-282-5349
Provider Business Practice Location Address Fax Number:
740-282-5340
Provider Enumeration Date:
01/18/2007

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: 207VG0400X , with the licence number:  35.037113 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1508919341 . This is a "TYPE I INDIVIDUAL NPI #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341191014002 . This is a "MED MUT GROUP NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0432213 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1807015000 . This is a "WV WELFARE PROVIDER #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0022513 . This is a "BOX 24K MT STATE BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341191014026 . This is a "CARESOURCE PROVIDER #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: A37113 . This is a "HEALTH PLAN PROVIDER #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1346324514 . This is a "TYPE II NPI #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000128366 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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