Provider Demographics
NPI:1487102729
Name:ARTEAGA, ELISA
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:ARTEAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15372 AVEIRO RD
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-0979
Mailing Address - Country:US
Mailing Address - Phone:909-519-8329
Mailing Address - Fax:
Practice Address - Street 1:15372 AVEIRO RD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-0979
Practice Address - Country:US
Practice Address - Phone:909-519-8329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program