Healthcare Provider Details

I. General information

NPI: 1649150236
Provider Name (Legal Business Name): MARIBEL ELIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 FOXTAIL ST
LEHIGH ACRES FL
33974-9615
US

IV. Provider business mailing address

840 FOXTAIL ST E
LEHIGH ACRES FL
33974
US

V. Phone/Fax

Practice location:
  • Phone: 321-234-7426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number282818381
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: