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General NPI Number Information
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NPI Number | 1982058194
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Entity Type | Individual
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Provider Name | ELENA CECILIA SANZ MIRALLES DDS, MS, PHD
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Gender | Female
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 2581 SAMARITAN DR STE 310
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City | SAN JOSE
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State | CA
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Zip | 95124-4112
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Country | US
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Telephone | 917-856-1601
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Fax |
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Provider Business Mailing Address
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Address Line | 6303 BANNOCKBURN DR
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City | BETHESDA
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State | MD
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Zip | 20817-5403
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Country | US
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Telephone |
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 000068
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 0401415593
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DDS105533
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License Number State | CA
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