Healthcare Provider Details

I. General information

NPI: 1780889295
Provider Name (Legal Business Name): SCOTT A ELIZONDO LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 W VERMONT AVE
ESCONDIDO CA
92025-6584
US

IV. Provider business mailing address

1246 CAPISTRANO LN
VISTA CA
92081-6327
US

V. Phone/Fax

Practice location:
  • Phone: 760-480-2255
  • Fax:
Mailing address:
  • Phone: 760-727-1759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 51742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: