Healthcare Provider Details

I. General information

NPI: 1205226891
Provider Name (Legal Business Name): ELAN ACADEMIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3158 RED HILL AVE STE 150
COSTA MESA CA
92626-3428
US

IV. Provider business mailing address

3158 RED HILL AVE STE 150
COSTA MESA CA
92626-3428
US

V. Phone/Fax

Practice location:
  • Phone: 714-966-2312
  • Fax: 714-966-2317
Mailing address:
  • Phone: 714-966-2312
  • Fax: 714-966-2317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPSY22346
License Number StateCA

VIII. Authorized Official

Name: MRS. MIMA RANSOM
Title or Position: BUSINESS MANAGER
Credential:
Phone: 714-966-2312