Provider Demographics
NPI:1417342437
Name:ATENCIO, ELVIS O (PHARM D)
Entity Type:Individual
Prefix:
First Name:ELVIS
Middle Name:O
Last Name:ATENCIO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:897 BUEN TIEMPO DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6556
Mailing Address - Country:US
Mailing Address - Phone:619-507-3969
Mailing Address - Fax:
Practice Address - Street 1:897 BUEN TIEMPO DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-6556
Practice Address - Country:US
Practice Address - Phone:619-507-3969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist