Healthcare Provider Details

I. General information

NPI: 1538180153
Provider Name (Legal Business Name): ELENA KRON ECT.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 3RD AVE #121
CHULA VISTA CA
91911-1300
US

IV. Provider business mailing address

5091 VIA PLAYA LOS SANTOS
SAN DIEGO CA
92124-1554
US

V. Phone/Fax

Practice location:
  • Phone: 619-427-2289
  • Fax: 619-426-3427
Mailing address:
  • Phone: 858-277-3509
  • Fax: 619-278-9615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberSL1219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: