Provider Demographics
NPI:1851342521
Name:ZHU, ELISE Q (MD)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:Q
Last Name:ZHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2200
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-0722
Mailing Address - Country:US
Mailing Address - Phone:909-862-1191
Mailing Address - Fax:909-862-2768
Practice Address - Street 1:7000 BOULDER AVE
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-3348
Practice Address - Country:US
Practice Address - Phone:909-862-1191
Practice Address - Fax:909-862-2768
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA607572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A607570OtherBLUE SHIELD
CA00A607570Medicaid
WA60757KMedicare ID - Type Unspecified
CA00A607570Medicaid