Provider Demographics
NPI:1487832770
Name:ELOISA G. DIMAYUGA, MD PA
Entity Type:Organization
Organization Name:ELOISA G. DIMAYUGA, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELOISA
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIMAYUGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-451-5940
Mailing Address - Street 1:226 N NOVA RD STE 320
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5124
Mailing Address - Country:US
Mailing Address - Phone:386-451-5940
Mailing Address - Fax:
Practice Address - Street 1:303 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2709
Practice Address - Country:US
Practice Address - Phone:386-451-5940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
40553OtherMEDICARE GROUP NUMBER
FL40553Medicare PIN