Provider Demographics
NPI:1326489311
Name:MARTINEZ-AGUILAR, ELVIA
Entity Type:Individual
Prefix:MRS
First Name:ELVIA
Middle Name:
Last Name:MARTINEZ-AGUILAR
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 1:16 MONTICELLO BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3404
Mailing Address - Country:US
Mailing Address - Phone:302-322-4964
Mailing Address - Fax:
Practice Address - Street 1:318 E BASIN RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4214
Practice Address - Country:US
Practice Address - Phone:302-323-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1435728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DESAL119137224001OtherHIGHMARK DELAWARE BLUE CROSS BLUE SHIELD