MEDICARE: AMY PATRICIA ELKIND RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	542671	CA

General Provider Information

NPI Number	:	1417570607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY PATRICIA ELKIND RN

Provider Business Mailing Address
First Line	:	4530 LISANN ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-2438
Country	:	US
Telephone Number	:	858-472-1584
Fax Number	:

Provider Business Practice Location Address
First Line	:	3341 BROWNING ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-1514
Country	:	US
Telephone Number	:	619-223-4518
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2020
Last Update Date	:	05/21/2020

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