Healthcare Provider Details
I. General information
NPI: 1265848972
Provider Name (Legal Business Name): ELLIOT HANDLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 07/02/2014
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3800 W CHAPMAN AVE STE 500
ORANGE CA
92868-1638
US
IV. Provider business mailing address
200 S MANCHESTER AVE STE 300
ORANGE CA
92868-3219
US
V. Phone/Fax
- Phone: 714-456-5902
- Fax:
- Phone: 714-456-2986
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 59411 |
| License Number State | MN |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2084P0804X |
| Taxonomy | Child & Adolescent Psychiatry Physician |
| License Number | A164334 |
| License Number State | CA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: