Provider Demographics
NPI:1558375022
Name:HARTWICK, ELSA MARIA (MD)
Entity Type:Individual
Prefix:MS
First Name:ELSA
Middle Name:MARIA
Last Name:HARTWICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ELSA
Other - Middle Name:MARIA
Other - Last Name:AGUINIGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2550 W MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1694
Mailing Address - Country:US
Mailing Address - Phone:626-457-6900
Mailing Address - Fax:213-743-9001
Practice Address - Street 1:1414 S GRAND AVE STE 380
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3072
Practice Address - Country:US
Practice Address - Phone:213-222-1300
Practice Address - Fax:213-222-1333
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA065743207R00000X
CAA65743207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H60941Medicare UPIN
WA65743AMedicare ID - Type Unspecified