Healthcare Provider Details

I. General information

NPI: 1174711436
Provider Name (Legal Business Name): AMY CLAIRE ELLSWORTH PA-C,MMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY CLAIRE GUZZO PA-C

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12865 POINTE DEL MAR WAY SUITE #160
DEL MAR CA
92014-3860
US

IV. Provider business mailing address

319 F ST STE 102
CHULA VISTA CA
91910-2666
US

V. Phone/Fax

Practice location:
  • Phone: 858-350-7546
  • Fax: 858-350-8282
Mailing address:
  • Phone: 619-476-1200
  • Fax: 619-429-7849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA19249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: