Provider Demographics
NPI:1659788644
Name:DUVAL, ELBA (BS)
Entity Type:Individual
Prefix:MRS
First Name:ELBA
Middle Name:
Last Name:DUVAL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 W 24TH CT
Mailing Address - Street 2:UNIT #104
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6337
Mailing Address - Country:US
Mailing Address - Phone:786-252-6647
Mailing Address - Fax:
Practice Address - Street 1:6321 BIRD RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4825
Practice Address - Country:US
Practice Address - Phone:305-461-4702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI 13442355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSI 1344OtherDEPARTMENT OF HEALTH LICENSE