Provider Demographics
NPI:1992701338
Name:ELY, EVELYN ABIUE (MD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:ABIUE
Last Name:ELY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1665 SCENIC AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:714-436-4444
Mailing Address - Fax:714-436-4812
Practice Address - Street 1:1665 SCENIC AVE
Practice Address - Street 2:STE. 100
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:714-436-4444
Practice Address - Fax:714-436-4812
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2008-09-24
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Provider Licenses
StateLicense IDTaxonomies
CAA46639208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A466390OtherMEDI CAL #
CAF12467Medicare UPIN