Provider Demographics
NPI:1124751805
Name:ELIAS, LUZ MARIA
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:MARIA
Last Name:ELIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 WAKEHAM AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5953
Mailing Address - Country:US
Mailing Address - Phone:714-975-1438
Mailing Address - Fax:714-546-5037
Practice Address - Street 1:1406 W EDINGER AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-4307
Practice Address - Country:US
Practice Address - Phone:714-546-6191
Practice Address - Fax:714-546-5037
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH34735183700000X
CA34735183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician