Provider Demographics
NPI:1376936740
Name:ELIZONDO, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:ELIZONDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 CORONA DR
Mailing Address - Street 2:STE. 234
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4324
Mailing Address - Country:US
Mailing Address - Phone:361-854-1110
Mailing Address - Fax:855-448-9769
Practice Address - Street 1:4444 CORONA DR
Practice Address - Street 2:STE. 234
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4324
Practice Address - Country:US
Practice Address - Phone:361-854-1110
Practice Address - Fax:855-448-9769
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201927224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant