Healthcare Provider Details

I. General information

NPI: 1467356154
Provider Name (Legal Business Name): ANAYAHGRACE EVE ELSEN AS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 CRAVEN ST
SAN DIEGO CA
92136-5596
US

IV. Provider business mailing address

8420 WENATCHEE AVE
EL CAJON CA
92021-1062
US

V. Phone/Fax

Practice location:
  • Phone: 619-556-8797
  • Fax:
Mailing address:
  • Phone: 620-605-8260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number14952
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: