MEDICARE: DR. DIANA I ELIZALDE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	68677	AZ
2	207R00000X	Internal Medicine Physician	68677	AZ

General Provider Information

NPI Number	:	1922661032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA I ELIZALDE M.D.

Provider Business Mailing Address
First Line	:	4720 E GREENWAY RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4355
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4720 E GREENWAY RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4355
Country	:	US
Telephone Number	:	602-439-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2019
Last Update Date	:	04/14/2026

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