MEDICARE: MS. ELSA GARDNER RN

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	163W00000X	Registered Nurse	796295	CA

General Provider Information

NPI Number	:	1457740680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELSA GARDNER RN

Provider Business Mailing Address
First Line	:	1014 1/2 N VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2620
Country	:	US
Telephone Number	:	213-284-3115
Fax Number	:

Provider Business Practice Location Address
First Line	:	1014 1/2 N VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2620
Country	:	US
Telephone Number	:	213-284-3115
Fax Number	:

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

Provider Enumeration Date	:	01/12/2015
Last Update Date	:	01/12/2015

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