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General NPI Number Information
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NPI Number | 1487832770
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Entity Type | Organization
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Legal Business Name | ELOISA G. DIMAYUGA, MD PA
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Dates
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Enumeration Date | 02/08/2008
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 303 N CLYDE MORRIS BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2709
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Country | US
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Telephone | 386-451-5940
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Fax |
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Provider Business Mailing Address
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Address Line | 226 N NOVA RD STE 320
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5124
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Country | US
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Telephone | 386-451-5940
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELOISA G DIMAYUGA
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Credential | MD
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Telephone | 386-451-5940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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