Provider Demographics
NPI:1083987051
Name:MARCIA ELFENBAUM, MD INC.
Entity Type:Organization
Organization Name:MARCIA ELFENBAUM, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELFENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-514-4116
Mailing Address - Street 1:PO BOX 927854
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92192-7854
Mailing Address - Country:US
Mailing Address - Phone:858-514-4116
Mailing Address - Fax:858-514-4118
Practice Address - Street 1:4282 GENESEE AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4963
Practice Address - Country:US
Practice Address - Phone:858-514-4116
Practice Address - Fax:858-514-4118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA633692081P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A633690Medicaid
H20398Medicare UPIN