Basic Information
| Provider Information | |||||||||
| NPI: | 1568089951 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELIZONDO | ||||||||
| FirstName: | KAREN | ||||||||
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| Credential: | RT (R) | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3415 POND CIR | ||||||||
| Address2: | |||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777073676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4094448122 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2830 CALDER ST | ||||||||
| Address2: | |||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777021809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098927171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2020 | ||||||||
| LastUpdateDate: | 07/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | GMR02005400 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.