Healthcare Provider Details

I. General information

NPI: 1205491255
Provider Name (Legal Business Name): RANI ELIAS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/06/2019
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:
Mailing address:
  • Phone: 909-581-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RANI ELIAS
Title or Position: OWNER
Credential: MD
Phone: 909-419-4056