=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124370846
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANAS ELIAS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2012
-----------------------------------------------------
Last Update Date | 10/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 WESTERN AVE STE 204
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92411-1353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-474-9952
-----------------------------------------------------
Fax | 909-474-9951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1559
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93302-1559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-635-3050
-----------------------------------------------------
Fax | 661-635-3070
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | A144754
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------