Healthcare Provider Details

I. General information

NPI: 1891650289
Provider Name (Legal Business Name): CARLY ELGIN RN,BSN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24411 AMADOR ST
HAYWARD CA
94544-1301
US

IV. Provider business mailing address

24411 AMADOR ST
HAYWARD CA
94544-1301
US

V. Phone/Fax

Practice location:
  • Phone: 510-954-2301
  • Fax: 510-582-8805
Mailing address:
  • Phone: 510-954-2301
  • Fax: 510-582-8805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number820779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: