Provider Demographics
NPI:1649626284
Name:ELIZONDO, RICARDO (NURSE)
Entity type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:
Last Name:ELIZONDO
Suffix:
Gender:M
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13737 NOEL RD STE 1400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-2004
Mailing Address - Country:US
Mailing Address - Phone:214-754-8700
Mailing Address - Fax:877-614-6192
Practice Address - Street 1:4099 MCEWEN RD STE 200
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-5050
Practice Address - Country:US
Practice Address - Phone:214-754-8700
Practice Address - Fax:877-614-6192
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209809164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse