Provider Demographics
NPI:1548968779
Name:ELIAS, ANDREA (LMT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ELIAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8238 OAKDALE AVE # A
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-1937
Mailing Address - Country:US
Mailing Address - Phone:747-232-8708
Mailing Address - Fax:
Practice Address - Street 1:8238 OAKDALE AVE # A
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-1937
Practice Address - Country:US
Practice Address - Phone:747-232-8708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91582225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty