Healthcare Provider Details

I. General information

NPI: 1649523929
Provider Name (Legal Business Name): ELIZABETH ERIN KELIIHOLOKAI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ERIN FREY PA

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 E YORBA LINDA BLVD SUITE 210
PLACENTIA CA
92870-3728
US

IV. Provider business mailing address

7772 MERIDIAN ST
CHINO CA
91708-8832
US

V. Phone/Fax

Practice location:
  • Phone: 714-223-7000
  • Fax: 714-223-7001
Mailing address:
  • Phone: 909-495-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: