Healthcare Provider Details

I. General information

NPI: 1558810754
Provider Name (Legal Business Name): ELAN ALLISON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 WILSHIRE BLVD 310
LOS ANGELES CA
90017-3901
US

IV. Provider business mailing address

1127 WILSHIRE BLVD 310
LOS ANGELES CA
90017-3901
US

V. Phone/Fax

Practice location:
  • Phone: 213-250-7850
  • Fax: 213-250-7363
Mailing address:
  • Phone: 213-250-7850
  • Fax: 213-250-7363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCO005278
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO03792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: