Provider Demographics
NPI:1386679587
Name:ELIZONDO, EMMA MARGOT (MD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:MARGOT
Last Name:ELIZONDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 PLEASANTON RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221
Mailing Address - Country:US
Mailing Address - Phone:210-923-3942
Mailing Address - Fax:210-923-3983
Practice Address - Street 1:2718 PLEASANTON RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221
Practice Address - Country:US
Practice Address - Phone:210-923-3942
Practice Address - Fax:210-923-3983
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032991401Medicaid
TX00EK16Medicare ID - Type Unspecified
TX032991401Medicaid