Healthcare Provider Details

I. General information

NPI: 1194087155
Provider Name (Legal Business Name): RANI ELIAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9710 19TH ST
RANCHO CUCAMONGA CA
91737-3538
US

IV. Provider business mailing address

9710 19TH ST
RANCHO CUCAMONGA CA
91737-3538
US

V. Phone/Fax

Practice location:
  • Phone: 909-581-0008
  • Fax: 909-581-0030
Mailing address:
  • Phone: 909-581-0008
  • Fax: 909-581-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA121684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: