Healthcare Provider Details

I. General information

NPI: 1386268738
Provider Name (Legal Business Name): ELISABETH ANNE PLOTNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISABETH A PLOTNER-PAWLEWICZ MD

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9909 MIRA MESA BLVD STE 200
SAN DIEGO CA
92131-1061
US

IV. Provider business mailing address

9333 GENESEE AVE STE 200
SAN DIEGO CA
92121-2113
US

V. Phone/Fax

Practice location:
  • Phone: 858-675-7750
  • Fax:
Mailing address:
  • Phone: 800-926-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT4825
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberT4825
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA182648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: