Provider Demographics
NPI:1225093297
Name:CHANG, ELIZABETH FLORES (NP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:FLORES
Last Name:CHANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 4792
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92514-4792
Mailing Address - Country:US
Mailing Address - Phone:909-271-5321
Mailing Address - Fax:
Practice Address - Street 1:11201 BENTON STREET
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:909-583-6720
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20173363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health