Provider Demographics
NPI:1063558856
Name:ANDERSON, ELAINE DE JESUS (HAD)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:DE JESUS
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:MOLINA
Other - Last Name:DE JESUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12927 SLEEPY WIND ST
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2935
Mailing Address - Country:US
Mailing Address - Phone:619-426-0841
Mailing Address - Fax:619-426-9197
Practice Address - Street 1:310 3RD AVE
Practice Address - Street 2:STE C11
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3953
Practice Address - Country:US
Practice Address - Phone:619-426-0841
Practice Address - Fax:619-426-9197
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 7100237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist