Provider Demographics
NPI:1194952853
Name:ELFTMAN, SUSAN NANCY (PA)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:NANCY
Last Name:ELFTMAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1760 TERMINO
Mailing Address - Street 2:#223 CHISATO OBA MD
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804
Mailing Address - Country:US
Mailing Address - Phone:562-344-1280
Mailing Address - Fax:562-344-1285
Practice Address - Street 1:1760 TERMINO
Practice Address - Street 2:#223 CHISATO OBA MD
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804
Practice Address - Country:US
Practice Address - Phone:562-344-1280
Practice Address - Fax:562-344-1285
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA10805(EXP04-2011)363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant