Healthcare Provider Details

I. General information

NPI: 1396101366
Provider Name (Legal Business Name): ELISEA JOSE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9436 SLAUSON AVE
PICO RIVERA CA
90660-4748
US

IV. Provider business mailing address

9436 SLAUSON AVE
PICO RIVERA CA
90660-4748
US

V. Phone/Fax

Practice location:
  • Phone: 562-949-6069
  • Fax: 562-949-0199
Mailing address:
  • Phone: 562-949-6069
  • Fax: 562-949-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: