Healthcare Provider Details

I. General information

NPI: 1396936480
Provider Name (Legal Business Name): ELLINA BEKKERMAN-DONNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. YELENA BEKKERMAN

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 FORDHAM ST
SAN DIEGO CA
92110-5339
US

IV. Provider business mailing address

3250 FORDHAM ST
SAN DIEGO CA
92110-5339
US

V. Phone/Fax

Practice location:
  • Phone: 619-688-1600
  • Fax:
Mailing address:
  • Phone: 800-290-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA100144
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: