Organization
ELBA HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL A BONACCI PH.D. (OWNER)
(928) 257-4897
Entity
Organization
Contact information
Practice address
2450 S 4TH AVE, SUITE 201, YUMA, AZ 85364-8573
(928) 257-4897
(866) 534-1701
Mailing address
1349 E COLTER ST, PHOENIX, AZ 85014-3048
(928) 257-4897
(866) 534-1701
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
3376
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
872003
—
AZ
Enumeration date
01/16/2008
Last updated
01/16/2008
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