1194952853 NPI number — MS. SUSAN NANCY ELFTMAN P.A.

Table of content: MS. SUSAN NANCY ELFTMAN P.A. (NPI 1194952853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194952853 NPI number — MS. SUSAN NANCY ELFTMAN P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELFTMAN
Provider First Name:
SUSAN
Provider Middle Name:
NANCY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194952853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1760 TERMINO
Provider Second Line Business Mailing Address:
#223 CHISATO OBA MD
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-344-1280
Provider Business Mailing Address Fax Number:
562-344-1285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1760 TERMINO
Provider Second Line Business Practice Location Address:
#223 CHISATO OBA MD
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-344-1280
Provider Business Practice Location Address Fax Number:
562-344-1285
Provider Enumeration Date:
06/19/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA10805(EXP04-2011) , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)