Provider Demographics
NPI:1457384018
Name:MARROQUIN-ELIZONDO, TERESA (RD LD CDE)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:MARROQUIN-ELIZONDO
Suffix:
Gender:F
Credentials:RD LD CDE
Other - Prefix:
Other - First Name:MARIA-TERESITA
Other - Middle Name:DE JESUS
Other - Last Name:MARROQUIN-DE ELIZONDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 27829
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125
Mailing Address - Country:US
Mailing Address - Phone:505-232-1920
Mailing Address - Fax:505-727-9276
Practice Address - Street 1:5400 GIBSON BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-232-1920
Practice Address - Fax:505-727-9276
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM269163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator