Provider Demographics
NPI:1316078926
Name:RARA, ELISA VILLAFUERTE (DMD)
Entity type:Individual
Prefix:DR
First Name:ELISA
Middle Name:VILLAFUERTE
Last Name:RARA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39572 STEVENSON PL
Mailing Address - Street 2:SUITE 129
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3075
Mailing Address - Country:US
Mailing Address - Phone:510-794-6141
Mailing Address - Fax:510-794-0126
Practice Address - Street 1:39572 STEVENSON PL
Practice Address - Street 2:SUITE 129
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-3075
Practice Address - Country:US
Practice Address - Phone:510-794-6141
Practice Address - Fax:510-794-0126
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice