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General NPI Number Information
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NPI Number | 1174711436
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Entity Type | Individual
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Provider Name | AMY CLAIRE ELLSWORTH PA-C,MMS
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Gender | Female
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 12865 POINTE DEL MAR WAY SUITE #160
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City | DEL MAR
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State | CA
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Zip | 92014-3860
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Country | US
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Telephone | 858-350-7546
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Fax | 858-350-8282
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Provider Business Mailing Address
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Address Line | 319 F ST STE 102
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City | CHULA VISTA
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State | CA
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Zip | 91910-2666
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Country | US
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Telephone | 619-476-1200
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Fax | 619-429-7849
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA19249
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License Number State | CA
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