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General NPI Number Information
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NPI Number | 1043330277
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Entity Type | Organization
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Legal Business Name | ELLNER BARIATRIC INC
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 2878 CAMINO DEL RIO S STE 303
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City | SAN DIEGO
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State | CA
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Zip | 92108-3847
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Country | US
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Telephone | 619-286-7866
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Fax | 619-286-7867
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Provider Business Mailing Address
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Address Line | 2878 CAMINO DEL RIO S STE 303
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City | SAN DIEGO
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State | CA
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Zip | 92108-3847
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Country | US
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Telephone | 619-286-7866
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Fax | 619-286-7867
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Authorized Official
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Title or Position | OWNER
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Name | DR. JULIE A ELLNER
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Credential | MD
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Telephone | 619-286-7866
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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 | G85289
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License Number State | CA
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