Provider Demographics
NPI:1861260275
Name:ELLAS BELLAS LLC
Entity type:Organization
Organization Name:ELLAS BELLAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:PARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-774-0109
Mailing Address - Street 1:2275 N VOLUSIA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-2833
Mailing Address - Country:US
Mailing Address - Phone:386-774-0109
Mailing Address - Fax:386-774-1203
Practice Address - Street 1:2275 N VOLUSIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-2833
Practice Address - Country:US
Practice Address - Phone:386-774-0109
Practice Address - Fax:386-774-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty