Provider Demographics
NPI:1508273012
Name:DA SILVA, ELENA KAMAKANIKAILIALOHA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:KAMAKANIKAILIALOHA
Last Name:DA SILVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAKANI
Other - Middle Name:
Other - Last Name:DA SILVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPAS, MPH
Mailing Address - Street 1:1310 CLUB DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94592-1187
Mailing Address - Country:US
Mailing Address - Phone:707-638-5205
Mailing Address - Fax:707-638-5225
Practice Address - Street 1:2201 COURAGE DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6733
Practice Address - Country:US
Practice Address - Phone:707-784-2001
Practice Address - Fax:707-784-1494
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA51657363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant