Healthcare Provider Details

I. General information

NPI: 1770688814
Provider Name (Legal Business Name): EDWARD ELIZONDO CREMATA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/09/2020
Certification Date: 02/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39140 PASEO PADRE PKWY
FREMONT CA
94538-1612
US

IV. Provider business mailing address

39140 PASEO PADRE PKWY
FREMONT CA
94538-1612
US

V. Phone/Fax

Practice location:
  • Phone: 510-796-2225
  • Fax: 510-792-0802
Mailing address:
  • Phone: 510-796-2225
  • Fax: 925-952-4349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number14349
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95013805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: