MEDICARE: MRS. ANNA MARIE ELIAS M.A., CCC-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	231H00000X	Audiologist	AU 2129	CA
2	237600000X	Audiologist-Hearing Aid Fitter	HA 4099	CA

General Provider Information

NPI Number	:	1548448301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNA MARIE ELIAS M.A., CCC-A

Provider Business Mailing Address
First Line	:	11956 BERNARDO PLAZA DR
Second Line	:	PMB 311
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2538
Country	:	US
Telephone Number	:	949-282-1212
Fax Number	:	858-676-0126

Provider Business Practice Location Address
First Line	:	16486 BERNARDO CENTER DR
Second Line	:	SUITE 128
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2518
Country	:	US
Telephone Number	:	949-282-1212
Fax Number	:	858-676-0126

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

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	02/04/2008

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