Healthcare Provider Details

I. General information

NPI: 1003104936
Provider Name (Legal Business Name): MARGARET V ELIZONDO MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7860 FORRESTAL RD
SAN DIEGO CA
92120-2207
US

IV. Provider business mailing address

PO BOX 2993
LA MESA CA
91943-2993
US

V. Phone/Fax

Practice location:
  • Phone: 619-507-4652
  • Fax:
Mailing address:
  • Phone: 619-507-4652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG71918
License Number StateCA

VIII. Authorized Official

Name: DR. MARGARET V ELIZONDO
Title or Position: PRESIDENT
Credential: M.D
Phone: 619-507-4652