Provider Demographics
NPI:1760847586
Name:ELION BRACE MD INC
Entity Type:Organization
Organization Name:ELION BRACE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ELION
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-275-2792
Mailing Address - Street 1:PO BOX 211988
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91921-1988
Mailing Address - Country:US
Mailing Address - Phone:619-836-3229
Mailing Address - Fax:619-272-3644
Practice Address - Street 1:450 4TH AVE STE 408
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4430
Practice Address - Country:US
Practice Address - Phone:619-934-5767
Practice Address - Fax:619-691-5977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105638207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty