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General NPI Number Information
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NPI Number | 1730987637
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Entity Type | Individual
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Provider Name | BROOKE ELCONIN PA-C
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Gender |
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 350 30TH ST STE 100
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City | OAKLAND
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State | CA
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Zip | 94609-3422
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Country | US
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Telephone | 510-204-1844
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Fax |
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Provider Business Mailing Address
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Address Line | 1826 EDDY ST UNIT 102
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City | SAN FRANCISCO
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State | CA
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Zip | 94115-3947
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Country | US
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Telephone | 818-522-5079
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA66102
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 66102
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License Number State | CA
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