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General NPI Number Information
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NPI Number | 1588989412
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Entity Type | Individual
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Provider Name | MISTY ELERYAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/04/2010
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 13157 MINDANAO WAY # 329
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6307
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Country | US
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Telephone | 310-564-2782
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Fax | 310-564-2782
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Provider Business Mailing Address
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Address Line | 13157 MINDANAO WAY # 329
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6307
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 70096
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 22506
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License Number State | ND
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A168938
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 70096
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License Number State | AZ
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Taxonomy #5
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | A168938
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | A168938
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License Number State | CA
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