Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | A63369 | CA |
NPI | 1184640583 |
---|---|
Provider Name | Marcia Elana Elfenbaum |
First Address | San Diego, CA 92192-7854 |
Second Address | San Diego, CA 92117-4946 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A633690 | (05) | CA |
H20398 | (02) |