Provider Demographics
NPI:1255047908
Name:ARRUDA, ELIZABETH REGINA (LAC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:REGINA
Last Name:ARRUDA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2305 PINE ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-6122
Mailing Address - Country:US
Mailing Address - Phone:210-284-7752
Mailing Address - Fax:
Practice Address - Street 1:8145 BALTIMORE AVE STE 205
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-2491
Practice Address - Country:US
Practice Address - Phone:240-528-7655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02981171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist