Healthcare Provider Details

I. General information

NPI: 1124751805
Provider Name (Legal Business Name): LUZ MARIA ELIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 W EDINGER AVE
SANTA ANA CA
92704-4307
US

IV. Provider business mailing address

333 WAKEHAM AVE
SANTA ANA CA
92701-5953
US

V. Phone/Fax

Practice location:
  • Phone: 714-546-6191
  • Fax: 714-546-5037
Mailing address:
  • Phone: 714-975-1438
  • Fax: 714-546-5037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH34735
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number34735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: