Healthcare Provider Details

I. General information

NPI: 1417570607
Provider Name (Legal Business Name): AMY PATRICIA ELKIND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 BROWNING ST
SAN DIEGO CA
92106-1514
US

IV. Provider business mailing address

4530 LISANN ST
SAN DIEGO CA
92117-2438
US

V. Phone/Fax

Practice location:
  • Phone: 619-223-4518
  • Fax:
Mailing address:
  • Phone: 858-472-1584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number542671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: