Provider Demographics
NPI:1780362285
Name:DE LA MONEDA, ELISA MARIE (CTRS)
Entity type:Individual
Prefix:MISS
First Name:ELISA
Middle Name:MARIE
Last Name:DE LA MONEDA
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 SW 5TH PL
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3911
Mailing Address - Country:US
Mailing Address - Phone:813-382-4669
Mailing Address - Fax:
Practice Address - Street 1:6301 SW 5TH PL
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-3911
Practice Address - Country:US
Practice Address - Phone:813-382-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85181225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist