Provider Demographics
NPI:1407289200
Name:ELIZONDO, DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
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 1:5460 PAREDES LINE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-9741
Mailing Address - Country:US
Mailing Address - Phone:956-554-0010
Mailing Address - Fax:956-554-3288
Practice Address - Street 1:5460 PAREDES LINE RD STE 200
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-9741
Practice Address - Country:US
Practice Address - Phone:956-554-0010
Practice Address - Fax:956-554-3288
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT8524207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400318104Medicaid
WI1407289200Medicaid