Provider Demographics
NPI:1144789926
Name:ELIAS, ZAIDA LORAINE (AA, BA, QABAT)
Entity Type:Individual
Prefix:
First Name:ZAIDA
Middle Name:LORAINE
Last Name:ELIAS
Suffix:
Gender:F
Credentials:AA, BA, QABAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3734
Mailing Address - Country:US
Mailing Address - Phone:559-358-0284
Mailing Address - Fax:
Practice Address - Street 1:177 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3734
Practice Address - Country:US
Practice Address - Phone:559-358-0284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician