Provider Demographics
NPI:1033100722
Name:GIRALDO, ELIAS A (MD)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:A
Last Name:GIRALDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17285 RACHELS WAY
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6368
Mailing Address - Country:US
Mailing Address - Phone:901-277-0192
Mailing Address - Fax:
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324
Practice Address - Country:US
Practice Address - Phone:909-580-6267
Practice Address - Fax:909-580-1727
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1237742084A2900X, 2084N0400X
MN535672084N0400X
TN363902084N0400X
MN1050852084N0400X
CAC1550692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3876217Medicaid
MNENROLLEDMedicaid
IAENROLLEDMedicaid
TN3876217Medicare PIN
MN130001532Medicare PIN
H42561Medicare UPIN