Provider Demographics
NPI:1689962946
Name:FINK, ELLEN EMILY (MS, PAC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:EMILY
Last Name:FINK
Suffix:
Gender:F
Credentials:MS, PAC
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:EMILY
Other - Last Name:DEUPARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:858-822-6277
Practice Address - Fax:858-228-1731
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA52655363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M74460 579Medicare PIN