Provider Demographics
NPI:1194087155
Name:ELIAS, RANI (MD)
Entity type:Individual
Prefix:
First Name:RANI
Middle Name:
Last Name:ELIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9710 19TH ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-3538
Mailing Address - Country:US
Mailing Address - Phone:909-581-0008
Mailing Address - Fax:909-581-0030
Practice Address - Street 1:9710 19TH ST
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-3538
Practice Address - Country:US
Practice Address - Phone:909-581-0008
Practice Address - Fax:909-581-0030
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121684208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A121684Medicaid