Provider Demographics
NPI:1750023446
Name:ELIZONDO, KIRA NIKOLE (MD)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:NIKOLE
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 1:2157 E APACHE BLVD APT 2065
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-0605
Mailing Address - Country:US
Mailing Address - Phone:956-251-2139
Mailing Address - Fax:
Practice Address - Street 1:7400 BARLITE BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1308
Practice Address - Country:US
Practice Address - Phone:210-921-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program