Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 26731 | CA |
NPI | 1053707281 |
---|---|
Provider Name | Mrs. Michele Leann Elvander |
First Address | Costa Mesa, CA 92626-2708 |
Second Address | Costa Mesa, CA 92626-2708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2015 |
Last Update Date | 14/04/2015 |