=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003104936
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARGARET V ELIZONDO MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2011
-----------------------------------------------------
Last Update Date | 07/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7860 FORRESTAL RD
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92120-2207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-507-4652
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2993
-----------------------------------------------------
City | LA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91943-2993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-507-4652
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARGARET V ELIZONDO
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 619-507-4652
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | G71918
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------