Provider Demographics
NPI:1154725273
Name:FIGUEROA, ELISADEL (MD)
Entity type:Individual
Prefix:
First Name:ELISADEL
Middle Name:
Last Name:FIGUEROA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60465
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-0465
Mailing Address - Country:US
Mailing Address - Phone:361-500-4351
Mailing Address - Fax:361-857-0572
Practice Address - Street 1:3315 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1820
Practice Address - Country:US
Practice Address - Phone:361-761-1000
Practice Address - Fax:361-884-2919
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18860208D00000X
TXS5896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS5896OtherTEXAS MEDICAL LICENSE