Provider Demographics
NPI:1003690314
Name:ELIE FILS, CLIVENS
Entity Type:Individual
Prefix:
First Name:CLIVENS
Middle Name:
Last Name:ELIE FILS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5424 SUNOL BLVD
Mailing Address - Street 2:STE 10
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7705
Mailing Address - Country:US
Mailing Address - Phone:561-667-3788
Mailing Address - Fax:
Practice Address - Street 1:5424 SUNOL BLVD STE 10
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7705
Practice Address - Country:US
Practice Address - Phone:561-667-3788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61468824363LP0808X
MTAPRN-218080363LP0808X
OR10011485363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health