Provider Demographics
NPI:1487095576
Name:KHURY, ELYAS Y (RNCST)
Entity type:Individual
Prefix:
First Name:ELYAS
Middle Name:Y
Last Name:KHURY
Suffix:
Gender:M
Credentials:RNCST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12810 SIERRA CREEK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-8466
Mailing Address - Country:US
Mailing Address - Phone:714-493-4831
Mailing Address - Fax:
Practice Address - Street 1:12810 SIERRA CREEK DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-8466
Practice Address - Country:US
Practice Address - Phone:714-493-4831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA710246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic