1780095539 NPI number — MRS. PATRICIA ALICE ELDER RN, IBCLC

Table of content: MRS. PATRICIA ALICE ELDER RN, IBCLC (NPI 1780095539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780095539 NPI number — MRS. PATRICIA ALICE ELDER RN, IBCLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELDER
Provider First Name:
PATRICIA
Provider Middle Name:
ALICE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, IBCLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GILMORE
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
ALICE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780095539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1648 VIA ARRIBA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALOS VERDES ESTATES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90274-1233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-378-1958
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1648 VIA ARRIBA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALOS VERDES ESTATES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90274-1233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-378-1958
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2014

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: 163WL0100X , with the licence number:  304850 , 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)





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