Provider Demographics
NPI:1184640583
Name:ELFENBAUM, MARCIA ELANA (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:ELANA
Last Name:ELFENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Mailing Address - Fax:
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:92117-4946
Practice Address - Country:US
Practice Address - Phone:858-514-4116
Practice Address - Fax:858-514-4118
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA633692081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A633690Medicaid
CA00A633690Medicaid
A63369Medicare ID - Type Unspecified