Healthcare Provider Details

I. General information

NPI: 1295409019
Provider Name (Legal Business Name): ELSA DAVALOS-CHOMINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5870 EL CAMINO REAL STE 101
CARLSBAD CA
92008-8816
US

IV. Provider business mailing address

1929 O AVE
NATIONAL CITY CA
91950-6031
US

V. Phone/Fax

Practice location:
  • Phone: 760-539-5818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: