Healthcare Provider Details

I. General information

NPI: 1841399235
Provider Name (Legal Business Name): JOHN FERNANDO N ELIAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: J. FERNANDO ELIAS M.D.

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SPANOS CT STE 121
MODESTO CA
95355-2810
US

IV. Provider business mailing address

1401 SPANOS CT STE 121
MODESTO CA
95355-2810
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-3135
  • Fax: 209-525-3193
Mailing address:
  • Phone: 209-525-3135
  • Fax: 209-525-3193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA039877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: