Provider Demographics
NPI:1952446247
Name:ELEA D. ENGLISH M.D. INC
Entity Type:Organization
Organization Name:ELEA D. ENGLISH M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-272-1400
Mailing Address - Street 1:41230 11TH ST W
Mailing Address - Street 2:SUITE D
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1411
Mailing Address - Country:US
Mailing Address - Phone:661-272-1400
Mailing Address - Fax:661-272-9499
Practice Address - Street 1:41230 11TH ST W
Practice Address - Street 2:SUITE D
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1411
Practice Address - Country:US
Practice Address - Phone:661-272-1400
Practice Address - Fax:661-272-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20459OtherMEDICARE GROUP ID
CAWA33623AOtherMEDICARE PPIN
CAA33623OtherMEDICAL LICENSE
CAA27203Medicare UPIN