Provider Demographics
NPI:1669961744
Name:ELIZONDO, DAISY M (LBSW)
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:M
Last Name:ELIZONDO
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 RIVERBEND ST
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-5730
Mailing Address - Country:US
Mailing Address - Phone:956-437-6805
Mailing Address - Fax:
Practice Address - Street 1:1035 RIVERBEND ST
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-5730
Practice Address - Country:US
Practice Address - Phone:956-437-6805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50428171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator