Healthcare Provider Details

I. General information

NPI: 1134510589
Provider Name (Legal Business Name): ELLIOT THOMAS MIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 LA CASA VIA STE 102
WALNUT CREEK CA
94598-3092
US

IV. Provider business mailing address

120 LA CASA VIA STE 102
WALNUT CREEK CA
94598-3092
US

V. Phone/Fax

Practice location:
  • Phone: 925-867-1900
  • Fax: 925-867-1901
Mailing address:
  • Phone: 925-867-1900
  • Fax: 925-867-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA142420
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD61279013
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME150080
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: