Provider Demographics
NPI:1477108652
Name:ELIZONDO, IRENE ROJAS
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:ROJAS
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 1:29535 YOSEMITE SPRINGS PKWY
Mailing Address - Street 2:
Mailing Address - City:COARSEGOLD
Mailing Address - State:CA
Mailing Address - Zip Code:93614-9160
Mailing Address - Country:US
Mailing Address - Phone:559-341-0129
Mailing Address - Fax:
Practice Address - Street 1:29535 YOSEMITE SPRINGS PKWY
Practice Address - Street 2:
Practice Address - City:COARSEGOLD
Practice Address - State:CA
Practice Address - Zip Code:93614-9160
Practice Address - Country:US
Practice Address - Phone:559-341-0129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285676164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse