Healthcare Provider Details

I. General information

NPI: 1861260275
Provider Name (Legal Business Name): ELLAS BELLAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 N VOLUSIA AVE STE 100
ORANGE CITY FL
32763-2833
US

IV. Provider business mailing address

2275 N VOLUSIA AVE
ORANGE CITY FL
32763-2833
US

V. Phone/Fax

Practice location:
  • Phone: 386-774-0109
  • Fax: 386-774-1203
Mailing address:
  • Phone: 386-774-0109
  • Fax: 386-774-1203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LUIS E. PARDO
Title or Position: CEO
Credential: MD
Phone: 386-774-0109