Provider Demographics
NPI:1780448290
Name:ELSTER, ALYICE RHNEE
Entity type:Individual
Prefix:
First Name:ALYICE
Middle Name:RHNEE
Last Name:ELSTER
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 1:13460 PRAIRIE AVE APT 23
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6087
Mailing Address - Country:US
Mailing Address - Phone:323-443-5965
Mailing Address - Fax:
Practice Address - Street 1:13460 PRAIRIE AVE APT 23
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6087
Practice Address - Country:US
Practice Address - Phone:323-443-5965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30194225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist