Healthcare Provider Details

I. General information

NPI: 1659705689
Provider Name (Legal Business Name): ALLAN CONCEPCION ELARMO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23180 HEMLOCK AVE STE 201
MORENO VALLEY CA
92557-8001
US

IV. Provider business mailing address

23180 HEMLOCK AVENUE SUITE 201
MORENO VALLEY CA
92557-8001
US

V. Phone/Fax

Practice location:
  • Phone: 951-243-6460
  • Fax: 951-243-5871
Mailing address:
  • Phone: 951-243-6460
  • Fax: 951-243-5871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: