Provider Demographics
NPI:1174711436
Name:ELLSWORTH, AMY CLAIRE (PA-C,MMS)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:CLAIRE
Last Name:ELLSWORTH
Suffix:
Gender:F
Credentials:PA-C,MMS
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:CLAIRE
Other - Last Name:GUZZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:319 F ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2666
Mailing Address - Country:US
Mailing Address - Phone:619-476-1200
Mailing Address - Fax:619-429-7849
Practice Address - Street 1:12865 POINTE DEL MAR WAY
Practice Address - Street 2:SUITE #160
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3860
Practice Address - Country:US
Practice Address - Phone:858-350-7546
Practice Address - Fax:858-350-8282
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19249363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical