Provider Demographics
NPI:1407057102
Name:ELIAS, AVERY ERIC (MHSII)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:ERIC
Last Name:ELIAS
Suffix:
Gender:M
Credentials:MHSII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 COURAGE DR
Mailing Address - Street 2:M.S.10-300
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6717
Mailing Address - Country:US
Mailing Address - Phone:707-784-2046
Mailing Address - Fax:707-784-2103
Practice Address - Street 1:2101 COURAGE DR
Practice Address - Street 2:M.S.10-300
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6717
Practice Address - Country:US
Practice Address - Phone:707-784-2046
Practice Address - Fax:707-784-2103
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker