Active NPI
Bernardo Elizondo, PA-C
- Physician Assistant
- San Diego, CA
National Provider Identifier
1790043248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 61853
- Practice address
- Naval Special Warfare Command 2000 Trident Way BLDG 624
San Diego, CA 92155-0001 - Phone
- (619) 537-1171
- NPI assigned
- May 2, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | |||
| Physician Assistant | 363A00000X | 61853 | CA | Primary |
Addresses
Primary practice location
Naval Special Warfare Command 2000 Trident Way BLDG 624
San Diego, CA 92155-0001
Mailing address
Naval Special Warfare Command 2000 Trident Way BLDG 624
San Diego, CA 92155-0001
Phone (619) 537-1171
Other practice location 1
937 Franklin Ave
Lemoore, CA 93246
Phone (559) 998-4800 ext. 1
Other practice location 2
34800 Bob Wilson Dr
San Diego, CA 92134-1098
Phone (619) 532-6400
Other practice location 3
Charles Momsen
DDG 92
Fpo, AP 96672-1307
Phone (956) 251-6603
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712707200000",
"number": "1790043248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "NAVAL SPECIAL WARFARE COMMAND 2000 TRIDENT WAY BLDG 624",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921550001",
"telephone_number": "619-537-1171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "NAVAL SPECIAL WARFARE COMMAND 2000 TRIDENT WAY BLDG 624",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921550001",
"telephone_number": "619-537-1171"
}
],
"practiceLocations": [
{
"address_1": "937 Franklin Ave",
"address_purpose": "LOCATION",
"city": "Lemoore",
"state": "CA",
"postal_code": "93246",
"country_code": "US",
"telephone_number": "559-998-4800 x1",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "34800 Bob Wilson Dr",
"address_purpose": "LOCATION",
"city": "San Diego",
"state": "CA",
"postal_code": "921341098",
"country_code": "US",
"telephone_number": "619-532-6400",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "Charles Momsen",
"address_2": "DDG 92",
"address_purpose": "LOCATION",
"city": "FPO",
"state": "AP",
"postal_code": "966721307",
"country_code": "US",
"telephone_number": "956-251-6603",
"country_name": "United States",
"address_type": "MIL"
}
],
"basic": {
"last_name": "ELIZONDO",
"first_name": "BERNARDO",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-05-02",
"last_updated": "2024-04-10",
"certification_date": "2024-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "61853",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.