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General NPI Number Information
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NPI Number | 1568089951
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Entity Type | Individual
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Provider Name | KAREN ELIZONDO RT (R)
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Gender | Female
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Dates
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Enumeration Date | 07/01/2020
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 2830 CALDER ST
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City | BEAUMONT
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State | TX
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Zip | 77702-1809
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Country | US
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Telephone | 409-892-7171
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Fax |
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Provider Business Mailing Address
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Address Line | 3415 POND CIR
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City | BEAUMONT
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State | TX
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Zip | 77707-3676
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Country | US
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Telephone | 409-444-8122
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | GMR02005400
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License Number State | TX
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