Provider Demographics
NPI:1760496145
Name:ELLIOTT, DEIRDRE DAVINA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:DAVINA
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4130 LA JOLLA VILLAGE DRIVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-452-3882
Mailing Address - Fax:858-452-3992
Practice Address - Street 1:4130 LA JOLLA VILLAGE DRIVE
Practice Address - Street 2:SUITE 301
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-452-3882
Practice Address - Fax:858-452-3992
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG527382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry