Provider Demographics
NPI:1043367162
Name:ELENA P. VITUG M.D., INC.
Entity type:Organization
Organization Name:ELENA P. VITUG M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:PENAFLOR
Authorized Official - Last Name:VITUG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-475-6204
Mailing Address - Street 1:520 BAYONA LOOP
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7967
Mailing Address - Country:US
Mailing Address - Phone:619-475-6204
Mailing Address - Fax:619-475-5174
Practice Address - Street 1:502 EUCLID AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2931
Practice Address - Country:US
Practice Address - Phone:619-475-6204
Practice Address - Fax:619-475-5174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44349261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care