Healthcare Provider Details

I. General information

NPI: 1407918733
Provider Name (Legal Business Name): RAUL ELGUEZABAL P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 FOURTH AVE STE 506
CHULA VISTA CA
91910-4414
US

IV. Provider business mailing address

480 FOURTH AVE STE 506
CHULA VISTA CA
91910-4414
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-4100
  • Fax: 619-662-4130
Mailing address:
  • Phone: 619-662-4100
  • Fax: 619-662-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number15431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: