Provider Demographics
NPI:1720286446
Name:GUERIN, ELAINA S (DO)
Entity Type:Individual
Prefix:
First Name:ELAINA
Middle Name:S
Last Name:GUERIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ELAINA
Other - Middle Name:S
Other - Last Name:MIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2021 CARLETON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-3244
Mailing Address - Country:US
Mailing Address - Phone:510-717-0312
Mailing Address - Fax:
Practice Address - Street 1:1411 E 31ST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1018
Practice Address - Country:US
Practice Address - Phone:510-535-7540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9683207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine