Provider Demographics
NPI:1528373560
Name:ATABA, ELAINE FRANCIS (LAC)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:FRANCIS
Last Name:ATABA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4469 MORRELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4642
Mailing Address - Country:US
Mailing Address - Phone:858-272-7330
Mailing Address - Fax:
Practice Address - Street 1:4469 MORRELL ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4642
Practice Address - Country:US
Practice Address - Phone:858-272-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-14
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12853171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist