Provider Demographics
NPI:1861480972
Name:UBALS, ELENA M (MD)
Entity Type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:M
Last Name:UBALS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 SW 87TH AVE
Mailing Address - Street 2:SUITE C-340
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3570
Mailing Address - Country:US
Mailing Address - Phone:305-595-0109
Mailing Address - Fax:305-595-2836
Practice Address - Street 1:7800 SW 87TH AVE
Practice Address - Street 2:SUITE C-340
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3570
Practice Address - Country:US
Practice Address - Phone:305-595-0109
Practice Address - Fax:305-595-2836
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039515207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043092702Medicaid
FL53829YMedicare ID - Type Unspecified
FLD56671Medicare UPIN