Jacqueline Ann Elizondo, LAT, OTC, ROT, OPE-C

Primary specialty

Orthopedic AssistantTaxonomy code 246ZX2200X

License

20-0612 Issued in TX

Practice address

4110 22ND PL
Lubbock, TX 79410-1122

Phone

(806) 792-4329

Fax

(806) 792-4329

NPI assigned

Apr 22, 2021

Last updated

Oct 19, 2022By the provider in NPPES

Sex

Female

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

State licenses

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

{
    "created_epoch": "1619049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666137600000",
    "number": "1811579683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6912 E FM 1729",
            "city": "IDALOU",
            "state": "TX",
            "postal_code": "793296306",
            "telephone_number": "210-421-4346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 22ND PL",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101122",
            "telephone_number": "806-792-4329",
            "fax_number": "806-792-4329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELIZONDO",
        "first_name": "JACQUELINE",
        "middle_name": "ANN",
        "credential": "LAT, OTC, ROT, OPE-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-22",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZX2200X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Orthopedic Assistant",
            "state": "TX",
            "license": "20-0612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emadeldeen M Ahmed Elgwairi, MD
• Elias Ghandour, MD, PA
• Eliot Dennard PHD
• Elite Primary Care and Wellness, PLLC
• Clarissa Syvonne Elizondo, PA
• Jose E Elizondo, PAC
• Joshua Eric Elizondo, PTA
• Pamela J. Elkins, NP
• Karsen Elliot
• Ashley Elliott, DNAP, CRNA

• Other Specialist/Technologist in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Other Specialist/Technologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2022; 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.