Provider Demographics
NPI:1548448301
Name:ELIAS, ANNA MARIE (MA, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIE
Last Name:ELIAS
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11956 BERNARDO PLAZA DR
Mailing Address - Street 2:PMB 311
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2538
Mailing Address - Country:US
Mailing Address - Phone:949-282-1212
Mailing Address - Fax:858-676-0126
Practice Address - Street 1:16486 BERNARDO CENTER DR
Practice Address - Street 2:SUITE 128
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2518
Practice Address - Country:US
Practice Address - Phone:949-282-1212
Practice Address - Fax:858-676-0126
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 2129231H00000X
CAHA 4099237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter