Provider Demographics
NPI:1447377668
Name:LOERA, ELSA A
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:A
Last Name:LOERA
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 1:9220 E AVENUE Q14
Mailing Address - Street 2:
Mailing Address - City:LITTLEROCK
Mailing Address - State:CA
Mailing Address - Zip Code:93543-4044
Mailing Address - Country:US
Mailing Address - Phone:661-944-9132
Mailing Address - Fax:
Practice Address - Street 1:43423 DIVISION ST
Practice Address - Street 2:SUITE 107
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4639
Practice Address - Country:US
Practice Address - Phone:661-726-2850
Practice Address - Fax:661-726-2854
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner