Provider Demographics
NPI:1710544713
Name:HESS, ELIZABETH AN
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:AN
Last Name:HESS
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 1:1365 CRAFTON AVE APT 2092
Mailing Address - Street 2:
Mailing Address - City:MENTONE
Mailing Address - State:CA
Mailing Address - Zip Code:92359-1354
Mailing Address - Country:US
Mailing Address - Phone:909-371-4272
Mailing Address - Fax:
Practice Address - Street 1:1365 CRAFTON AVE APT 2092
Practice Address - Street 2:
Practice Address - City:MENTONE
Practice Address - State:CA
Practice Address - Zip Code:92359-1354
Practice Address - Country:US
Practice Address - Phone:909-371-4272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician