Healthcare Provider Details

I. General information

NPI: 1235697376
Provider Name (Legal Business Name): ELIAS CHRISTOPHER FRANGOS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 SHERIDAN ST
PORT TOWNSEND WA
98368-2443
US

IV. Provider business mailing address

12696 KIOWA RD
APPLE VALLEY CA
92308-6962
US

V. Phone/Fax

Practice location:
  • Phone: 360-344-1001
  • Fax: 360-412-6473
Mailing address:
  • Phone: 650-245-2257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA61637192
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number56639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: