Provider Demographics
NPI:1609997618
Name:ORELLANA, ELBIN ALFREDO SR (MD)
Entity Type:Individual
Prefix:DR
First Name:ELBIN
Middle Name:ALFREDO
Last Name:ORELLANA
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ELBIN
Other - Middle Name:
Other - Last Name:ORELLANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3751 DEL REY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012
Mailing Address - Country:US
Mailing Address - Phone:575-382-3500
Mailing Address - Fax:575-382-4900
Practice Address - Street 1:3751 DEL REY BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012
Practice Address - Country:US
Practice Address - Phone:575-382-3500
Practice Address - Fax:575-382-4900
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2014-01152084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101761232Medicaid
MI260028405OtherRAILROAD MEDICARE
MI260D110460OtherBLUE CROSS
MIEO045303OtherMICHIGAN
MIAO1876309OtherDEA
MIAO1876309OtherDEA
MI260D110460OtherBLUE CROSS
MI38 2621627OtherTAX ID