Healthcare Provider Details

I. General information

NPI: 1750328720
Provider Name (Legal Business Name): ELVIRA KLAUSE MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 06/01/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23961 CALLE DE LA MAGDALENA STE 417
LAGUNA HILLS CA
92653-3616
US

IV. Provider business mailing address

23961 CALLE DE LA MAGDALENA STE 417
LAGUNA HILLS CA
92653-3616
US

V. Phone/Fax

Practice location:
  • Phone: 949-276-8050
  • Fax: 949-609-0504
Mailing address:
  • Phone: 949-276-8050
  • Fax: 949-609-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG81744
License Number StateCA

VIII. Authorized Official

Name: ELVIRA KLAUSE
Title or Position: OWNER
Credential: M.D
Phone: 949-276-8050