Provider Demographics
NPI:1972112118
Name:ELEFANTE, DENNIS MADRIAGA
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:MADRIAGA
Last Name:ELEFANTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5106 JUNE CT
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-0032
Mailing Address - Country:US
Mailing Address - Phone:956-789-3616
Mailing Address - Fax:
Practice Address - Street 1:5106 JUNE CT
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-0032
Practice Address - Country:US
Practice Address - Phone:956-789-3616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX681559163WE0003X
TX1014781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency