Provider Demographics
NPI:1972776920
Name:ELIZONDO, ANA LUISA (MSPT)
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:LUISA
Last Name:ELIZONDO
Suffix:
Gender:F
Credentials:MSPT
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Other - First Name:
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Mailing Address - Street 1:6699 ALVARADO RD
Mailing Address - Street 2:STE 2100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5238
Mailing Address - Country:US
Mailing Address - Phone:619-229-3909
Mailing Address - Fax:619-229-3902
Practice Address - Street 1:4010 SORRENTO VALLEY BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1432
Practice Address - Country:US
Practice Address - Phone:858-793-7860
Practice Address - Fax:858-436-1289
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT 21304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB219438OtherMEDICARE PTAN