Provider Demographics
NPI:1831773910
Name:ORLOFF, ELLIOTT ANDRE
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:ANDRE
Last Name:ORLOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 LA CRESCENTA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1514
Mailing Address - Country:US
Mailing Address - Phone:818-636-5639
Mailing Address - Fax:
Practice Address - Street 1:3404 LA CRESCENTA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1514
Practice Address - Country:US
Practice Address - Phone:818-636-5639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program