Healthcare Provider Details

I. General information

NPI: 1013157965
Provider Name (Legal Business Name): ELBA CECILIA DIAZ TORO D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 CALLE MARGINAL VILLAMAR
CAROLINA PR
00979-6345
US

IV. Provider business mailing address

1225 CALLE MARGINAL VILLAMAR
CAROLINA PR
00979-6345
US

V. Phone/Fax

Practice location:
  • Phone: 787-630-7397
  • Fax:
Mailing address:
  • Phone: 787-630-7397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2222
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: