Provider Demographics
NPI:1558782029
Name:ELENES HIGUERA, EDITH (PAC)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:ELENES HIGUERA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-3352
Mailing Address - Country:US
Mailing Address - Phone:626-350-9540
Mailing Address - Fax:626-350-9580
Practice Address - Street 1:3030 TYLER AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3352
Practice Address - Country:US
Practice Address - Phone:626-350-9540
Practice Address - Fax:626-350-9580
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-30
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant