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General NPI Number Information
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NPI Number | 1033614706
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Entity Type | Organization
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Legal Business Name | ELLISON MEDICAL GROUP VEIN TREATMENT CENTER
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 06/02/2023
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Provider Practice Location Address
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Address Line | 5330 CARROLL CANYON RD STE 140
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City | SAN DIEGO
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State | CA
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Zip | 92121-3758
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Country | US
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Telephone | 858-926-7678
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Fax | 347-405-8161
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Provider Business Mailing Address
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Address Line | 6220 AVENIDA LOMA DE ORO #675731
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City | RANCHO SANTA FE
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State | CA
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Zip | 92027
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Country | US
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Telephone | 858-926-7678
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Fax | 347-405-8161
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM SCHOENFELD
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Credential | MD
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Telephone | 858-926-7678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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