Healthcare Provider Details

I. General information

NPI: 1659476984
Provider Name (Legal Business Name): MARIA ELENA IMPERIAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 EUCLID ST DEPARTMENT PICU PEDS
FOUNTAIN VALLEY CA
92708
US

IV. Provider business mailing address

17100 EUCLID ST DEPARTMENT PICU PEDS
FOUNTAIN VALLEY CA
92708
US

V. Phone/Fax

Practice location:
  • Phone: 714-966-7253
  • Fax: 714-966-3354
Mailing address:
  • Phone: 714-966-7253
  • Fax: 714-966-3354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberC50939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: