Healthcare Provider Details

I. General information

NPI: 1497244792
Provider Name (Legal Business Name): MATTHEW JOHN ELLIOTT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 N INDIAN CANYON DR
PALM SPRINGS CA
92262-4880
US

IV. Provider business mailing address

1330 N INDIAN CANYON DR
PALM SPRINGS CA
92262-4880
US

V. Phone/Fax

Practice location:
  • Phone: 760-864-4163
  • Fax:
Mailing address:
  • Phone: 760-864-4163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number55415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: