Provider Demographics
NPI:1184790131
Name:ELIAS, ELLIOTT, LAMPASI, FEHN, & HARRIS ADP
Entity type:Organization
Organization Name:ELIAS, ELLIOTT, LAMPASI, FEHN, & HARRIS ADP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-689-5031
Mailing Address - Street 1:1380 EL SOBRANTE RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-5759
Mailing Address - Country:US
Mailing Address - Phone:951-273-9580
Mailing Address - Fax:
Practice Address - Street 1:1380 EL SOBRANTE RD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-5759
Practice Address - Country:US
Practice Address - Phone:951-273-9580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA394011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty