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General NPI Number Information
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NPI Number | 1336812403
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Entity Type | Individual
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Provider Name | ELIZABETH ILIUTA DDS
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Gender | Female
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Dates
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Enumeration Date | 07/26/2021
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Last Update Date | 09/06/2021
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Provider Practice Location Address
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Address Line | 609 W ACEQUIA AVE
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City | VISALIA
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State | CA
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Zip | 93291-6165
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Country | US
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Telephone | 559-625-2040
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Fax |
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Provider Business Mailing Address
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Address Line | 2177 N LINWOOD ST N/A
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City | VISALIA
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State | CA
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Zip | 93291
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Country | US
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Telephone | 559-300-0258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 106382
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License Number State | CA
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