Provider Demographics
NPI:1073101564
Name:DINGBAUM, ELIZABETH ANN (PA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:DINGBAUM
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:150 VALPREDA RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2973
Mailing Address - Country:US
Mailing Address - Phone:760-736-6767
Mailing Address - Fax:760-736-8740
Practice Address - Street 1:605 CROUCH ST BLDG C
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4415
Practice Address - Country:US
Practice Address - Phone:760-736-6767
Practice Address - Fax:760-736-8740
Is Sole Proprietor?:No
Enumeration Date:2021-01-09
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA59243363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical