Healthcare Provider Details

I. General information

NPI: 1588943898
Provider Name (Legal Business Name): GEORGE RENE ELIAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 PACIFIC COAST HWY STE 330
HERMOSA BEACH CA
90254-2227
US

IV. Provider business mailing address

645 W 9TH ST UNIT 110-314
LOS ANGELES CA
90015-1640
US

V. Phone/Fax

Practice location:
  • Phone: 424-209-8020
  • Fax:
Mailing address:
  • Phone: 424-209-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number134990
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: