MEDICARE: GAYLE ELEVADO

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	363LG0600X	Gerontology Nurse Practitioner	95005213	CA
2	363LA2200X	Adult Health Nurse Practitioner	95005213	CA

General Provider Information

NPI Number	:	1578014494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLE ELEVADO

Provider Business Mailing Address
First Line	:	9360 SUNLAND PARK DR
Second Line	:	7
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-1654
Country	:	US
Telephone Number	:	818-640-1971
Fax Number	:

Provider Business Practice Location Address
First Line	:	9233 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1386
Country	:	US
Telephone Number	:	310-356-8146
Fax Number	:

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

Provider Enumeration Date	:	10/14/2016
Last Update Date	:	12/07/2021

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Directions to “ GAYLE ELEVADO ” Practice Location

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