Provider Demographics
NPI:1689445173
Name:ALFARO, ELVA V (RDH)
Entity Type:Individual
Prefix:MRS
First Name:ELVA
Middle Name:V
Last Name:ALFARO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ELVA
Other - Middle Name:V
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1810 W 12TH ST APT 301
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-4183
Mailing Address - Country:US
Mailing Address - Phone:213-434-4493
Mailing Address - Fax:
Practice Address - Street 1:1810 W 12TH ST APT 301
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4183
Practice Address - Country:US
Practice Address - Phone:213-434-4493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH32384124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist