Provider Demographics
NPI:1427489483
Name:ELEVAZO, ROY ALLAN O (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ROY ALLAN
Middle Name:O
Last Name:ELEVAZO
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3553 ATLANTIC AVENUE #253
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807
Mailing Address - Country:US
Mailing Address - Phone:562-804-3575
Mailing Address - Fax:
Practice Address - Street 1:5220 CLARK AVE STE 400
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2625
Practice Address - Country:US
Practice Address - Phone:562-804-3575
Practice Address - Fax:562-286-8123
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000309363LP0808X, 363LP0808X
CA711927282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No282N00000XHospitalsGeneral Acute Care Hospital