Provider Demographics
NPI:1306015771
Name:DURDA, ELISA M
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:M
Last Name:DURDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 CROESUS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-4416
Mailing Address - Country:US
Mailing Address - Phone:210-979-9251
Mailing Address - Fax:210-979-9251
Practice Address - Street 1:147 CROESUS AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-4416
Practice Address - Country:US
Practice Address - Phone:210-979-9251
Practice Address - Fax:210-979-9251
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X
TX148010311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No372600000XNursing Service Related ProvidersAdult Companion