Provider Demographics
NPI:1811010010
Name:URREA, ELISA (LVN)
Entity Type:Individual
Prefix:MS
First Name:ELISA
Middle Name:
Last Name:URREA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:ELISA
Other - Middle Name:
Other - Last Name:LEYVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:45-801 SALTON ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4649
Mailing Address - Country:US
Mailing Address - Phone:760-702-1950
Mailing Address - Fax:
Practice Address - Street 1:83-912 AVE 45
Practice Address - Street 2:SUITE 8
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3338
Practice Address - Country:US
Practice Address - Phone:760-347-0494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA222846164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse