Healthcare Provider Details

I. General information

NPI: 1043229305
Provider Name (Legal Business Name): ELIZABETH E. PAYNE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W. CITRACADO PARKWAY SUITE 200
ESCONDIDO CA
92025-6428
US

IV. Provider business mailing address

625 W. CITRACADO PARKWAY SUITE 200
ESCONDIDO CA
92025-6428
US

V. Phone/Fax

Practice location:
  • Phone: 760-746-2641
  • Fax: 760-740-2178
Mailing address:
  • Phone: 760-746-2641
  • Fax: 760-740-2178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG74067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: