Provider Demographics
NPI:1588190227
Name:ELWAN, DEENA (MD)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:
Last Name:ELWAN
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 1:210 S PALISADE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5932
Mailing Address - Country:US
Mailing Address - Phone:805-922-0481
Mailing Address - Fax:805-925-5261
Practice Address - Street 1:210 S PALISADE DR STE 101
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5932
Practice Address - Country:US
Practice Address - Phone:805-922-0481
Practice Address - Fax:805-925-5261
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMDR-####207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology