Healthcare Provider Details

I. General information

NPI: 1225233786
Provider Name (Legal Business Name): MR. ROLF ROBIN ELLIOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34960 BOB WILSON DR
SAN DIEGO CA
92134-6099
US

IV. Provider business mailing address

34960 BOB WILSON DR
SAN DIEGO CA
92134-6099
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8400
  • Fax:
Mailing address:
  • Phone: 619-532-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number74206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: