Elisabeth Ann Mack
Registered Nurse (General Practice)

Address: 4130 Maryland St, San Diego, CA 92103-2330
Phone: 6193703049

Elisabeth Ann Mack (NPI# 1780270900) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1780270900
Entity Type Individual
Full Name Elisabeth Ann Mack
Credential RN
Gender Female
Practice Address 4130 Maryland St
San Diego
CA 92103-2330
Practice Telephone 6193703049
Mailing Address 4130 Maryland St
San Diego
CA 92103-2330
Mailing Telephone 6193703049
Sole Proprietor Yes, this individual is a Sole Proprietor
Enumeration Date 2020-12-13
Last Update Date 2020-12-13

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 163WG0000X Registered Nurse · General Practice Nursing Service Providers RN452901 CA

Taxonomy Information

Taxonomy Code 163WG0000X
Grouping Nursing Service Providers
Classification Registered Nurse
Specialization General Practice

Taxonomy Definition

Definition to come...

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Office Location

Street Address 4130 MARYLAND ST
State CA
Zip Code 92103-2330

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1174140057 Carmel Agdeppa Acupuncturist Chiropractique, 813 West Washington St., San Diego, CA 92103 2020-06-26
1568082717 Salina Ann Bambic Social Worker 302 Washington Street Suite 420, San Diego, CA 92103 2020-04-17
1467099432 Lina Hong Behavior Technician 3731 6th Ave. Suite 100, San Diego, Ca 92103, San Diego, CA 92103 2019-12-09
1154964567 Rodger Stacy Questin, Psychologist P.C. Psychologist 440 Upas St Apt 402, San Diego, CA 92103 2019-10-18
1932740388 Grace Tong-ventura Pharmacist 200 W. Arbor Drive, #8765, Suite 1-317, San Diego, CA 92103 2019-10-07
1306490453 Genevieve Cheung Pharmacist 200 W Arbor Dr #8765, Department of Pharmacy, San Diego, CA 92103 2019-07-26
1801356837 Marika Doviak Acupuncturist 2370 Hickory St, San Diego, CA 92103 2019-03-25
1982185070 Tyler Lewis Roberts Counselor 4303 3rd Ave, San Diego, CA 92103 2018-08-27
1689151284 Tori Breanne Blackwell Occupational Therapist 3731-a 6th Avenue, San Diego, CA 92103 2018-07-26
1952892614 Pacific Bay Recovery Inc Substance Abuse Rehabilitation Facility 4095 Jackdaw St, San Diego, CA 92103 2018-05-29
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Zip Code 92103

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.