Provider Demographics
NPI:1740205525
Name:NATHANSON, ELVIE CERVAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELVIE
Middle Name:CERVAS
Last Name:NATHANSON
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 1:1926 MARQUIS CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3135
Mailing Address - Country:US
Mailing Address - Phone:619-420-1144
Mailing Address - Fax:619-420-2373
Practice Address - Street 1:340 4TH AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3813
Practice Address - Country:US
Practice Address - Phone:619-420-1144
Practice Address - Fax:619-420-2373
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice