Provider Demographics
NPI:1558763953
Name:LITRAS, ELENI (PA-C)
Entity Type:Individual
Prefix:
First Name:ELENI
Middle Name:
Last Name:LITRAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28120 BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2208
Mailing Address - Country:US
Mailing Address - Phone:951-672-7673
Mailing Address - Fax:951-672-1197
Practice Address - Street 1:28120 BRADLEY RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2208
Practice Address - Country:US
Practice Address - Phone:951-672-7673
Practice Address - Fax:951-672-1197
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018617363A00000X
CA51916363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY018617OtherNY STATE OFFICE OF THE PROFESSIONS
CA51916OtherPAC.CA.GOV