Provider Demographics
NPI:1881465367
Name:ELIORA LLC
Entity type:Organization
Organization Name:ELIORA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURETTA
Authorized Official - Middle Name:U
Authorized Official - Last Name:OGBUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-807-1714
Mailing Address - Street 1:2600 E SOUTHLAKE BLVD STE 120-342
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 TRAIL DUST DR
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-5733
Practice Address - Country:US
Practice Address - Phone:817-807-1714
Practice Address - Fax:917-898-1391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty