Provider Demographics
NPI:1346924420
Name:ROY ELEVAZO & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ROY ELEVAZO & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:ELEVAZO
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, PMHNP-BC
Authorized Official - Phone:562-804-3575
Mailing Address - Street 1:3553 ATLANTIC AVE # 253
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-5606
Mailing Address - Country:US
Mailing Address - Phone:562-684-8134
Mailing Address - Fax:
Practice Address - Street 1:5220 CLARK AVE STE 400
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2625
Practice Address - Country:US
Practice Address - Phone:562-804-3575
Practice Address - Fax:562-286-8123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty