Provider Demographics
NPI:1023881554
Name:SIRAG, ELIAS
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:
Last Name:SIRAG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14135 CERISE AVE APT 314
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-8497
Mailing Address - Country:US
Mailing Address - Phone:323-535-8561
Mailing Address - Fax:
Practice Address - Street 1:12841 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4413
Practice Address - Country:US
Practice Address - Phone:323-535-8561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle