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General NPI Number Information
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NPI Number | 1952620676
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Entity Type | Individual
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Provider Name | JOY SHALOMA ELLIOTT-DEMARS PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/20/2010
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Last Update Date | 08/29/2014
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Provider Practice Location Address
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Address Line | 4555 PRECISSI LN
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City | STOCKTON
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State | CA
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Zip | 95207-6239
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Country | US
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Telephone | 209-477-4103
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Fax | 209-477-1065
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Provider Business Mailing Address
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Address Line | 1691 THE ALAMEDA
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City | SAN JOSE
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State | CA
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Zip | 95126-2203
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Country | US
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Telephone | 408-795-3619
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Fax | 408-287-0405
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA22562
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License Number State | CA
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