Provider Demographics
NPI:1306834825
Name:DE LA SOTA, ELIZANDA MONICA (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZANDA
Middle Name:MONICA
Last Name:DE LA SOTA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 OLIVER LOVING TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1834
Mailing Address - Country:US
Mailing Address - Phone:512-329-0989
Mailing Address - Fax:512-329-0231
Practice Address - Street 1:901 S. MOPAC EXPWY.
Practice Address - Street 2:BARTON OAKS ONE, SUITE 480
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5787
Practice Address - Country:US
Practice Address - Phone:512-329-0989
Practice Address - Fax:512-329-0231
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23504103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR57534Medicare UPIN
TX00D62BMedicare ID - Type Unspecified