Healthcare Provider Details

I. General information

NPI: 1831115799
Provider Name (Legal Business Name): ELSA A TEKLE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 S BRISTOL ST
SANTA ANA CA
92704-6201
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 714-754-5454
  • Fax: 714-647-1245
Mailing address:
  • Phone: 800-883-7243
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA78066
License Number StateCA

VIII. Authorized Official

Name: DR. ELSA A TEKLE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 800-883-7243