MEDICARE: ELIAS, ELLIOTT, LAMPASI, FEHN, & HARRIS ADP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	39401	CA

General Provider Information

NPI Number	:	1184790131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIAS, ELLIOTT, LAMPASI, FEHN, & HARRIS ADP

Provider Business Mailing Address
First Line	:	1380 EL SOBRANTE RD
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-5759
Country	:	US
Telephone Number	:	951-273-9580
Fax Number	:

Provider Business Practice Location Address
First Line	:	1380 EL SOBRANTE RD
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-5759
Country	:	US
Telephone Number	:	951-273-9580
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	DON MA
Credential	:
Telephone Number	:	951-689-5031

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	08/22/2020

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