Provider Demographics
NPI:1518904580
Name:KLAUSE, ELVIRA (MD)
Entity Type:Individual
Prefix:
First Name:ELVIRA
Middle Name:
Last Name:KLAUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23961 CALLE DE LA MAGDALENA STE 417
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3616
Mailing Address - Country:US
Mailing Address - Phone:949-276-8050
Mailing Address - Fax:
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA STE 417
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3616
Practice Address - Country:US
Practice Address - Phone:949-276-8050
Practice Address - Fax:949-609-0504
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81744208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G817440Medicaid
CAH87128Medicare UPIN
CAWG81744BMedicare PIN
CAW19440Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER