Provider Demographics
NPI:1417164518
Name:ELIAS, RAMIZ NAIM (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMIZ
Middle Name:NAIM
Last Name:ELIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 SHASTA DAISY TRL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-6972
Mailing Address - Country:US
Mailing Address - Phone:858-342-2226
Mailing Address - Fax:
Practice Address - Street 1:7695 CARDINAL CT
Practice Address - Street 2:SUITE 370-375
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3357
Practice Address - Country:US
Practice Address - Phone:858-384-6857
Practice Address - Fax:858-277-1475
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99956207R00000X, 282N00000X, 208M00000X, 208D00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No282N00000XHospitalsGeneral Acute Care Hospital
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB224033OtherMEDICARE PTAN