MEDICARE: MRS. ARACELI M ELIZONDO P.A.

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	363A00000X	Physician Assistant	PENDING

General Provider Information

NPI Number	:	1356541031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ARACELI M ELIZONDO P.A.

Provider Business Mailing Address
First Line	:	1401 S GRAND AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3010
Country	:	US
Telephone Number	:	213-748-2411
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 DEL PASO AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-3836
Country	:	US
Telephone Number	:	323-227-9660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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