Active NPI
Chantal Elizaga
- Physician Assistant
- San Rafael, CA
National Provider Identifier
1720693682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 60625
- Practice address
- 50 Acacia Ave
San Rafael, CA 94901-2230 - Phone
- (415) 457-4440
- NPI assigned
- Sep 8, 2020
- Last updated
- Feb 10, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 60625 | CA | Primary |
Addresses
Primary practice location
50 Acacia Ave
San Rafael, CA 94901-2230
Mailing address
643 S Orange Dr
Los Angeles, CA 90036-3507
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60625 | CA | MD | Pharmacist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Urgent Care Clinic/Center
- Sherman Oaks, CA
- NPI 1467849745
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644451200000",
"number": "1720693682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "643 S ORANGE DR",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900363507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 ACACIA AVE",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949012230",
"telephone_number": "415-457-4440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELIZAGA",
"first_name": "CHANTAL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-08",
"last_updated": "2022-02-10",
"certification_date": "2022-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "60625",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.