Provider Demographics
NPI:1093922817
Name:FRESCO, ELAINE (RN, CNM)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:
Last Name:FRESCO
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 N ALTA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-1801
Mailing Address - Country:US
Mailing Address - Phone:323-656-0246
Mailing Address - Fax:
Practice Address - Street 1:15251 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4401
Practice Address - Country:US
Practice Address - Phone:818-894-0974
Practice Address - Fax:818-894-0804
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife