Healthcare Provider Details

I. General information

NPI: 1609319946
Provider Name (Legal Business Name): ELLEHCAL OBGYN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 E ELDER ST STE F
FALLBROOK CA
92028-3079
US

IV. Provider business mailing address

1374 S MISSION RD UNIT 429
FALLBROOK CA
92028-4006
US

V. Phone/Fax

Practice location:
  • Phone: 760-645-3407
  • Fax: 760-990-4523
Mailing address:
  • Phone: 760-909-9435
  • Fax: 760-990-4523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC3940420
License Number StateCA

VIII. Authorized Official

Name: DR. ENCHANTA L. JENKINS
Title or Position: OWNER
Credential: M.D.
Phone: 760-909-9435