Provider Demographics
NPI:1205989589
Name:ELAZEGUI, NONATO H (DMD)
Entity type:Individual
Prefix:DR
First Name:NONATO
Middle Name:H
Last Name:ELAZEGUI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12384 AVENUE 416 STE AB
Mailing Address - Street 2:
Mailing Address - City:OROSI
Mailing Address - State:CA
Mailing Address - Zip Code:93647-9463
Mailing Address - Country:US
Mailing Address - Phone:559-528-2244
Mailing Address - Fax:559-528-4460
Practice Address - Street 1:12384 AVENUE 416 STE AB
Practice Address - Street 2:
Practice Address - City:OROSI
Practice Address - State:CA
Practice Address - Zip Code:93647-9463
Practice Address - Country:US
Practice Address - Phone:559-528-2244
Practice Address - Fax:559-528-4460
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA399561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice