Basic Information
| Provider Information | |||||||||
| NPI: | 1760847586 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELION BRACE MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 211988 | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919211988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6198363229 | ||||||||
| FaxNumber: | 6192723644 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 4TH AVE STE 408 | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919104430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6199345767 | ||||||||
| FaxNumber: | 6196915977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2015 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| AuthorizedOfficialLastName: | BRACE | ||||||||
| AuthorizedOfficialFirstName: | ELION | ||||||||
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| AuthorizedOfficialTitleorPosition: | M.D. | ||||||||
| AuthorizedOfficialTelephone: | 7602752792 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A105638 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.