Healthcare Provider Details

I. General information

NPI: 1598264657
Provider Name (Legal Business Name): AARON ELDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 E HUNTINGTON DR
ARCADIA CA
91006-6203
US

IV. Provider business mailing address

1148 E JUANITA AVE
GLENDORA CA
91740-6105
US

V. Phone/Fax

Practice location:
  • Phone: 626-684-1243
  • Fax:
Mailing address:
  • Phone: 626-825-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number00005028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: