Healthcare Provider Details

I. General information

NPI: 1952607426
Provider Name (Legal Business Name): THOMAS K ELIAS CO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2011
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 FOREST AVE SUITE 3
SAN JOSE CA
95128-1478
US

IV. Provider business mailing address

1700 N CHRISMAN ROAD
TRACY CA
95304-9314
US

V. Phone/Fax

Practice location:
  • Phone: 408-217-9387
  • Fax: 408-866-4045
Mailing address:
  • Phone: 800-726-9180
  • Fax: 800-866-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCO002151
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: