Healthcare Provider Details

I. General information

NPI: 1730897372
Provider Name (Legal Business Name): ALAINA ELIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 E MAYO BLVD
PHOENIX AZ
85054-4502
US

IV. Provider business mailing address

12329 W SCOTTS DR
EL MIRAGE AZ
85335-5296
US

V. Phone/Fax

Practice location:
  • Phone: 734-645-7292
  • Fax:
Mailing address:
  • Phone: 734-645-7292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number249022
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: