Healthcare Provider Details

I. General information

NPI: 1942365572
Provider Name (Legal Business Name): ELKE LEE WURZBACH ELKE WURZBACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 E 120TH ST BLDG 14
LOS ANGELES CA
90059-3026
US

IV. Provider business mailing address

5650 JILLSON ST
COMMERCE CA
90040-1482
US

V. Phone/Fax

Practice location:
  • Phone: 562-867-7999
  • Fax:
Mailing address:
  • Phone: 323-201-4516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP12489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: