Provider Demographics
NPI:1861502247
Name:MCELFISH, GINA ROSE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:ROSE
Last Name:MCELFISH
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57570 SAN ANDREAS RD
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-4185
Mailing Address - Country:US
Mailing Address - Phone:760-365-8806
Mailing Address - Fax:
Practice Address - Street 1:57463 29 PALMS HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2925
Practice Address - Country:US
Practice Address - Phone:760-365-0808
Practice Address - Fax:760-365-4545
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC232435363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP0064540Medicaid
CAP26572Medicare UPIN