Ethan Michael Elizondo, DDS

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

4915 25TH Ave NE
Seattle, WA 98105-5667

Phone

(206) 524-1600

Fax

(206) 524-1603

NPI assigned

Jan 19, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674086400000",
    "number": "1679288104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 CIRCLE DR",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784111232",
            "telephone_number": "361-960-3687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4915 25TH AVE NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981055667",
            "telephone_number": "206-524-1600",
            "fax_number": "206-524-1603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELIZONDO",
        "first_name": "ETHAN",
        "middle_name": "MICHAEL",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-19",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elite Healthcare Medical Group, PLLC
• Elizabeth F. Chiulli DDS, PLLC
• Elizabeth Jordan MD PLLC
• Elizabeth Rogers Pilates & Physical Therapy, PLLC
• Shelby Marie Elizaga, ARNP, DNP
• Adrienne M Elkin
• Sara Lynne Elkington, LMHC
• Rena Elkins, LICSW
• Isaac Elkon
• Margaret Elkon, LMHC

• Student in an Organized Health Care Education/Training Program in Seattle, WA
• Providers in Seattle, WA by specialty
• Student in an Organized Health Care Education/Training Program in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.