Provider Demographics
NPI:1891875860
Name:ELDERS, DAWN (NP)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:ELDERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 MACERO STREET
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029
Mailing Address - Country:US
Mailing Address - Phone:760-747-8935
Mailing Address - Fax:760-747-7951
Practice Address - Street 1:215 S HICKORY ST
Practice Address - Street 2:SUITE 126
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4359
Practice Address - Country:US
Practice Address - Phone:760-747-8935
Practice Address - Fax:760-747-7951
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP14129207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNP14129AMedicare ID - Type Unspecified