Provider Demographics
NPI:1013005636
Name:DORINGO, ELAINIE D (MD)
Entity Type:Individual
Prefix:
First Name:ELAINIE
Middle Name:D
Last Name:DORINGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELAINIE
Other - Middle Name:OLIVERIA
Other - Last Name:DEVILLENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3860 CALLE FORTUNADA
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4802
Mailing Address - Country:US
Mailing Address - Phone:858-502-1135
Mailing Address - Fax:858-636-4319
Practice Address - Street 1:250 E. CHASE AVE.
Practice Address - Street 2:STE 108
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6035
Practice Address - Country:US
Practice Address - Phone:619-265-3400
Practice Address - Fax:619-265-3407
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70842208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics