Healthcare Provider Details

I. General information

NPI: 1245967041
Provider Name (Legal Business Name): YELINA BRITO ELIZARDEZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 WILLIAM ST SE
ALBUQUERQUE NM
87102-4661
US

IV. Provider business mailing address

1401 WILLIAM ST SE
ALBUQUERQUE NM
87102-4661
US

V. Phone/Fax

Practice location:
  • Phone: 505-768-5450
  • Fax:
Mailing address:
  • Phone: 505-768-5450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: