Provider Demographics
NPI:1184940678
Name:PACSON, ELLEN CAYMAN (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:CAYMAN
Last Name:PACSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2055 KELLOGG AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3111
Mailing Address - Country:US
Mailing Address - Phone:866-984-7483
Mailing Address - Fax:951-600-3469
Practice Address - Street 1:10800 MAGNOLIA AVEBUE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-9288
Practice Address - Country:US
Practice Address - Phone:951-353-4619
Practice Address - Fax:951-353-5838
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA123136207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program