Provider Demographics
NPI:1174380570
Name:ELIZONDO, JESUS ALEJANDRO
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:ALEJANDRO
Last Name:ELIZONDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-0339
Mailing Address - Country:US
Mailing Address - Phone:956-263-7374
Mailing Address - Fax:
Practice Address - Street 1:1343 13TH ST
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-0339
Practice Address - Country:US
Practice Address - Phone:956-263-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily