Healthcare Provider Details

I. General information

NPI: 1861183253
Provider Name (Legal Business Name): ELIZABETH CIFUENTES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILADELPHIA PA
19140-5103
US

IV. Provider business mailing address

1515 N MYRTLEWOOD ST
PHILADELPHIA PA
19121-3633
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-2000
  • Fax:
Mailing address:
  • Phone: 484-680-3938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT228090
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: