Provider Demographics
NPI:1629081914
Name:FARRULLA, DELIA ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:DELIA
Middle Name:ELIZABETH
Last Name:FARRULLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1068
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00954-1068
Mailing Address - Country:US
Mailing Address - Phone:787-870-2221
Mailing Address - Fax:787-870-1136
Practice Address - Street 1:165 AVE. JARDINES DE TOA ALTA 1RST. ST.
Practice Address - Street 2:RIO DEL PLATA MALL
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00954
Practice Address - Country:US
Practice Address - Phone:787-870-2221
Practice Address - Fax:787-870-1136
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice