Provider Demographics
NPI:1396936480
Name:BEKKERMAN-DONNER, ELLINA (MD)
Entity type:Individual
Prefix:DR
First Name:ELLINA
Middle Name:
Last Name:BEKKERMAN-DONNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:YELENA
Other - Middle Name:
Other - Last Name:BEKKERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3250 FORDHAM ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5339
Mailing Address - Country:US
Mailing Address - Phone:800-290-5000
Mailing Address - Fax:
Practice Address - Street 1:3250 FORDHAM ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5339
Practice Address - Country:US
Practice Address - Phone:619-688-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100144207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA100144Medicare UPIN