Healthcare Provider Details

I. General information

NPI: 1306015771
Provider Name (Legal Business Name): MRS. ELISA M. DURDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 CROESUS AVE
SAN ANTONIO TX
78213-4416
US

IV. Provider business mailing address

147 CROESUS AVE
SAN ANTONIO TX
78213-4416
US

V. Phone/Fax

Practice location:
  • Phone: 210-979-9251
  • Fax: 210-979-9251
Mailing address:
  • Phone: 210-979-9251
  • Fax: 210-979-9251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number148010
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: