Healthcare Provider Details

I. General information

NPI: 1184640583
Provider Name (Legal Business Name): MARCIA ELANA ELFENBAUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4282 GENESEE AVE SUITE 304
SAN DIEGO CA
92117-4946
US

IV. Provider business mailing address

PO BOX 927854
SAN DIEGO CA
92192-7854
US

V. Phone/Fax

Practice location:
  • Phone: 858-514-4116
  • Fax: 858-514-4118
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA63369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: