Provider Demographics
NPI:1497823405
Name:ELACION, JOSE M (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:ELACION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:3810 WILSHIRE BLVD
Mailing Address - Street 2:APT 503
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3204
Mailing Address - Country:US
Mailing Address - Phone:562-506-3001
Mailing Address - Fax:
Practice Address - Street 1:14427 CHASE ST
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-3020
Practice Address - Country:US
Practice Address - Phone:818-830-7751
Practice Address - Fax:818-891-7892
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2014-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC50675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C506750Medicaid
CAF43797Medicare UPIN
CAWC50675CMedicare PIN