Provider Demographics
NPI:1467604777
Name:MENDOZA, ELIZABETH COVARRUBIAS (CPNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:COVARRUBIAS
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:COVARRUBIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:1570 LOMALAND DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-4224
Mailing Address - Country:US
Mailing Address - Phone:915-590-4555
Mailing Address - Fax:915-590-4718
Practice Address - Street 1:1570 LOMALAND DR
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4224
Practice Address - Country:US
Practice Address - Phone:915-590-4555
Practice Address - Fax:915-590-4718
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX707287363LP0200X
TXAP116888363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics