Healthcare Provider Details

I. General information

NPI: 1285495754
Provider Name (Legal Business Name): ELAHA ELLA SHAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 PARNASSUS AVE
SAN FRANCISCO CA
94143-2210
US

IV. Provider business mailing address

3815 HUNTINGTON RD
WEST SACRAMENTO CA
95691-5485
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-5800
  • Fax:
Mailing address:
  • Phone: 279-759-1228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: