Provider Demographics
NPI:1184463192
Name:MAYORGA, ELIAS ALBERTO
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:ALBERTO
Last Name:MAYORGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 POWELL ST STE 409
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-3351
Mailing Address - Country:US
Mailing Address - Phone:484-622-7510
Mailing Address - Fax:
Practice Address - Street 1:1330 POWELL ST STE 409
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3351
Practice Address - Country:US
Practice Address - Phone:484-622-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program