Provider Demographics
NPI:1922106293
Name:CORTORREAL, ELSA GRULLON (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELSA
Middle Name:GRULLON
Last Name:CORTORREAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10550 N W 77 CT
Mailing Address - Street 2:#220
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:305-556-9473
Mailing Address - Fax:305-556-9486
Practice Address - Street 1:10550 N W 77 CT
Practice Address - Street 2:SUITE #220
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-556-9486
Practice Address - Fax:305-556-9486
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL114321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice