Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN14673 | FL |
Y | 213EG0000X | General Practice | DN14673 | FL |
N | 1223P0700X | Prosthodontist | DN14673 | FL |
NPI | 1255472387 |
---|---|
Provider Name | Dr. Ela Maria Torres-Moore |
First Address | Auburndale, FL 33823 |
Second Address | Lakeland, FL 33813-2181 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 04/03/2019 |