| NPI | 1962969261 |
|---|---|
| Former Legal Business Name | JORGE H ELIZALDE |
| Entity Type | Organization |
| Authorized Contact | JORGE HECTOR ELIZALDE Dentist 619-488-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-02-23 |
| Last Update Date | 2019-02-23 |