Provider Demographics
NPI:1528528569
Name:FANOUS, ELIAS JASON (MD)
Entity type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:JASON
Last Name:FANOUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2130 CITRACADO PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-4151
Mailing Address - Country:US
Mailing Address - Phone:951-902-9475
Mailing Address - Fax:
Practice Address - Street 1:2130 CITRACADO PKWY STE 220
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4151
Practice Address - Country:US
Practice Address - Phone:760-743-0546
Practice Address - Fax:760-317-9769
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA179829207R00000X, 207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program