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General NPI Number Information
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NPI Number | 1740205525
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Entity Type | Individual
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Provider Name | ELVIE CERVAS NATHANSON D.M.D
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Gender | Female
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 340 4TH AVE SUITE 16
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City | CHULA VISTA
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State | CA
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Zip | 91910-3813
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Country | US
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Telephone | 619-420-1144
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Fax | 619-420-2373
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Provider Business Mailing Address
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Address Line | 1926 MARQUIS CT
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City | CHULA VISTA
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State | CA
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Zip | 91913-3135
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Country | US
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Telephone | 619-420-1144
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Fax | 619-420-2373
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 49158
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License Number State | CA
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