Provider Demographics
NPI:1457341414
Name:ELIZONDO VEGA, HEATHER LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LEIGH
Last Name:ELIZONDO VEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:15502 STONEYBROOK WEST PKWY
Mailing Address - Street 2:SUITE 2-108
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4767
Mailing Address - Country:US
Mailing Address - Phone:210-287-7243
Mailing Address - Fax:
Practice Address - Street 1:15502 STONEYBROOK WEST PKWY
Practice Address - Street 2:SUITE 2-108
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4767
Practice Address - Country:US
Practice Address - Phone:210-287-7243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0551262080A0000X
FLME 1148242080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine