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General NPI Number Information
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NPI Number | 1083987051
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Entity Type | Organization
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Legal Business Name | MARCIA ELFENBAUM, MD INC.
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 4282 GENESEE AVE SUITE 304
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City | SAN DIEGO
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State | CA
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Zip | 92117-4963
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Country | US
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Telephone | 858-514-4116
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Fax | 858-514-4118
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Provider Business Mailing Address
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Address Line | PO BOX 927854
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City | SAN DIEGO
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State | CA
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Zip | 92192-7854
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Country | US
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Telephone | 858-514-4116
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Fax | 858-514-4118
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Authorized Official
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Title or Position | OWNER
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Name | MARCIA ELFENBAUM
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Credential | MD
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Telephone | 858-514-4116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | A63369
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | A63369
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License Number State | CA
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