Healthcare Provider Details

I. General information

NPI: 1437562048
Provider Name (Legal Business Name): STELLA ELBERG D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 NW 87TH AVE STE 5
DORAL FL
33172-1604
US

IV. Provider business mailing address

2801 NW 87TH AVE STE 5
DORAL FL
33172-1604
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-5155
  • Fax:
Mailing address:
  • Phone: 305-653-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS 12726
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: