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NPI Code Detail

MEDICARE: RYAN GABRIEL ELIAS COUNSELOR

MEDICARE: RYAN GABRIEL ELIAS COUNSELOR
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1487881637
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN GABRIEL ELIAS COUNSELOR
Provider Business Mailing Address
First Line : 18612 SANTA ANA AVE
Second Line :
City : BLOOMINGTON
State : CA
Zip : 92316-2639
Country : US
Telephone Number : 909-421-7120
Fax Number :
Provider Business Practice Location Address
First Line : 18612 SANTA ANA AVE
Second Line :
City : BLOOMINGTON
State : CA
Zip : 92316-2639
Country : US
Telephone Number : 909-421-7120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2009
Last Update Date : 10/21/2024

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