=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720895071
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELISA M DURDA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2024
-----------------------------------------------------
Last Update Date | 01/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 147 CROESUS AVE
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78213-4416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-452-8804
-----------------------------------------------------
Fax | 210-979-9251
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 147 CROESUS AVE
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78213-4416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-452-8804
-----------------------------------------------------
Fax | 210-979-9251
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADULT FOSTERCARE PROVIDER
-----------------------------------------------------
Name | ELISA M DURDA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-452-8804
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------