Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | C50190 | CA |
NPI | 1023127644 |
---|---|
Provider Name | Stephen J Elliott |
First Address | Cayucos, CA 93430-0344 |
Second Address | Mission Hills, CA 91345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E03346 | (02) | TX |