MEDICARE: ELAN ACADEMIES INC

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	103TC2200X	Clinical Child & Adolescent Psychologist	PSY22346	CA

General Provider Information

NPI Number	:	1821496282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELAN ACADEMIES INC

Provider Business Mailing Address
First Line	:	3158 RED HILL AVE SUITE 150
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626
Country	:	US
Telephone Number	:	714-966-2312
Fax Number	:	714-966-2317

Provider Business Practice Location Address
First Line	:	3158 RED HILL AVE STE 150
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-3428
Country	:	US
Telephone Number	:	714-966-2312
Fax Number	:	714-966-2317

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. ELIZABETH DELPIZZO-CHENG
Credential	:	PH , DA
Telephone Number	:	714-966-2312

Provider Enumeration Date	:	12/16/2014
Last Update Date	:	12/16/2014

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