Provider Demographics
NPI:1982684023
Name:ELIAS, SAMUEL J (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:ELIAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5805 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 610
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2546
Mailing Address - Country:US
Mailing Address - Phone:818-908-8048
Mailing Address - Fax:818-908-8072
Practice Address - Street 1:5525 ETIWANDA AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3647
Practice Address - Country:US
Practice Address - Phone:818-774-3838
Practice Address - Fax:818-774-3839
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2008-04-22
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Provider Licenses
StateLicense IDTaxonomies
CAA64627207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA64627AMedicare PIN
CAH60442Medicare UPIN