Provider Demographics
NPI:1326631607
Name:ELIZONDO, JOCELYN (DDS)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:ELIZONDO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 E SAN YSIDRO BLVD STE B3507
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-3129
Mailing Address - Country:US
Mailing Address - Phone:619-210-4712
Mailing Address - Fax:
Practice Address - Street 1:BLVD GRAL SANCHEZ TABOADA 9250
Practice Address - Street 2:ZONA RIO LOCAL 26
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22010
Practice Address - Country:MX
Practice Address - Phone:664-977-6267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ94591251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice