Basic Information
| Provider Information | |||||||||
| NPI: | 1023111093 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELOWITCH | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD PSY A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1238 ALESSANDRO DR | ||||||||
| Address2: | |||||||||
| City: | NEWBURY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913203503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057329446 | ||||||||
| FaxNumber: | 8054940575 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 S WELLS RD | ||||||||
| Address2: | CLINICAS DEL CAMINO REAL INC | ||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930041302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057329446 | ||||||||
| FaxNumber: | 8056477163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSB31421 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.