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General NPI Number Information
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NPI Number | 1700516325
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Entity Type | Individual
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Provider Name | CHRIS SIMON ELIAS NMT,CPT,SNS
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Gender | Male
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 1380 LEAD HILL BLVD STE 211
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City | ROSEVILLE
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State | CA
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Zip | 95661-2997
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Country | US
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Telephone | 916-359-9869
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Fax |
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Provider Business Mailing Address
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Address Line | 8458 N STAR WAY
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City | ORANGEVALE
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State | CA
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Zip | 95662-3843
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Country | US
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Telephone | 916-605-9691
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 87156
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License Number State | CA
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