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General NPI Number Information
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NPI Number | 1780198358
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Entity Type | Organization
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Legal Business Name | ELAN M. NEWMAN, M.D., INC
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Dates
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Enumeration Date | 11/18/2017
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Last Update Date | 01/07/2019
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Provider Practice Location Address
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Address Line | 11622 EL CAMINO REAL FL 1
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City | SAN DIEGO
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State | CA
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Zip | 92130-2049
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Country | US
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Telephone | 858-952-0715
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Fax |
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Provider Business Mailing Address
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Address Line | 6736 LOPEZ GLEN WAY
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City | SAN DIEGO
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State | CA
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Zip | 92126-6112
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Country | US
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Telephone | 858-952-0715
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Fax |
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Authorized Official
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Title or Position | DERMATOLOGIST/PRESIDENT
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Name | DR. ELAN MORDECI NEWMAN
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Credential | MD
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Telephone | 818-730-1629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A100748
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License Number State | CA
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