=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346324514
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELIZAGA & ELIZAGA ASSOCIATES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1524 SUNSET BLVD SUITE C
-----------------------------------------------------
City | STEUBENVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43952-1380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-282-5349
-----------------------------------------------------
Fax | 740-282-5340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1524 SUNSET BLVD SUITE C
-----------------------------------------------------
City | STEUBENVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43952-1380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-282-5349
-----------------------------------------------------
Fax | 740-282-5340
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TEODORA BALQUIEDRA ELIZAGA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 740-282-5349
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 35.037113
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------