Basic Information
| Provider Information | |||||||||
| NPI: | 1851673610 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELAMPARO | ||||||||
| FirstName: | KAYE | ||||||||
| MiddleName: | LIM | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 51449 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900516303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583096585 | ||||||||
| FaxNumber: | 8583096593 | ||||||||
| Practice Location | |||||||||
| Address1: | 9834 GENESEE AVE STE 310 | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920371221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8589099033 | ||||||||
| FaxNumber: | 8588156820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2011 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 163W00000X | 653081 | CA | N | Nursing Service Providers | Registered Nurse | 364S00000X | 3604 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | 363L00000X | 20795 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 20795 | 01 | CA | NURSE PRACTITIONER LICENSE | OTHER | 3604 | 01 | CA | CLINICAL NURSE LICENSE | OTHER | 653081 | 01 | CA | RN LICENSE | OTHER |