Healthcare Provider Details

I. General information

NPI: 1467996975
Provider Name (Legal Business Name): ELENA KHEGAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 ALTON PKWY
IRVINE CA
92618-3734
US

IV. Provider business mailing address

850 WYCLIFFE
IRVINE CA
92602-1218
US

V. Phone/Fax

Practice location:
  • Phone: 949-932-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number839851
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: