1740467372 NPI number — RICARDO R ELIZARDE & LUZ R ELIZARDE

Table of content: DAVID PAUL KRAWSEK RN (NPI 1760170229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740467372 NPI number — RICARDO R ELIZARDE & LUZ R ELIZARDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICARDO R ELIZARDE & LUZ R ELIZARDE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1740467372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
603 W VAN BUREN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLINGEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-412-4188
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603 W VAN BUREN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-412-4188
Provider Business Practice Location Address Fax Number:
956-412-8822
Provider Enumeration Date:
01/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ELIZARDE
Authorized Official First Name:
LUZ
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
956-412-8841

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  003460 , 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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