1649523929 NPI number — MRS. ELIZABETH ERIN KELIIHOLOKAI PA

Table of content: MRS. ELIZABETH ERIN KELIIHOLOKAI PA (NPI 1649523929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649523929 NPI number — MRS. ELIZABETH ERIN KELIIHOLOKAI PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELIIHOLOKAI
Provider First Name:
ELIZABETH
Provider Middle Name:
ERIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FREY
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
ERIN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649523929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7772 MERIDIAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91708-8832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-495-3006
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1041 E YORBA LINDA BLVD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
PLACENTIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92870-3728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-223-7000
Provider Business Practice Location Address Fax Number:
714-223-7001
Provider Enumeration Date:
10/24/2012

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:  PA21276 , 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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