Healthcare Provider Details

I. General information

NPI: 1811319007
Provider Name (Legal Business Name): ELIZABETH CONTRERAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 E FOOTHILL BLVD FL 2
PASADENA CA
91107-3406
US

IV. Provider business mailing address

2446 WORKMAN ST APT 222
LOS ANGELES CA
90031-2379
US

V. Phone/Fax

Practice location:
  • Phone: 626-744-5230
  • Fax:
Mailing address:
  • Phone: 323-479-5948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: