Provider Demographics
NPI:1366035842
Name:GAXIOLA, ELSBETH
Entity Type:Individual
Prefix:
First Name:ELSBETH
Middle Name:
Last Name:GAXIOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 STOCKER ST STE 104
Mailing Address - Street 2:
Mailing Address - City:VIEW PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90008-5145
Mailing Address - Country:US
Mailing Address - Phone:213-381-2931
Mailing Address - Fax:323-295-5648
Practice Address - Street 1:3701 STOCKER ST STE 104
Practice Address - Street 2:
Practice Address - City:VIEW PARK
Practice Address - State:CA
Practice Address - Zip Code:90008-5145
Practice Address - Country:US
Practice Address - Phone:213-381-2931
Practice Address - Fax:323-295-5648
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator