Provider Demographics
NPI:1649523929
Name:KELIIHOLOKAI, ELIZABETH ERIN (PA)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ERIN
Last Name:KELIIHOLOKAI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:ERIN
Other - Last Name:FREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7772 MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-8832
Mailing Address - Country:US
Mailing Address - Phone:909-495-3006
Mailing Address - Fax:
Practice Address - Street 1:1041 E YORBA LINDA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3728
Practice Address - Country:US
Practice Address - Phone:714-223-7000
Practice Address - Fax:714-223-7001
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant