Provider Demographics
NPI:1740270594
Name:ALANIS, ELSA (PHD)
Entity type:Individual
Prefix:DR
First Name:ELSA
Middle Name:
Last Name:ALANIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2609
Mailing Address - Country:US
Mailing Address - Phone:951-476-3555
Mailing Address - Fax:619-691-1144
Practice Address - Street 1:224 LANDIS AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2609
Practice Address - Country:US
Practice Address - Phone:951-476-3555
Practice Address - Fax:619-691-1144
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12555103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP12555Medicare ID - Type UnspecifiedMEDICARE