Healthcare Provider Details

I. General information

NPI: 1609855964
Provider Name (Legal Business Name): BRIAN DEAN ELCHINOFF DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2272 BACON STREET
CONCORD CA
94520
US

IV. Provider business mailing address

2272 BACON STREET
CONCORD CA
94520
US

V. Phone/Fax

Practice location:
  • Phone: 925-676-3933
  • Fax: 925-609-7255
Mailing address:
  • Phone: 925-676-3933
  • Fax: 925-609-7255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: