Provider Demographics
NPI:1780602300
Name:MELTZER, ELI OWEN (MD)
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:OWEN
Last Name:MELTZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5776 RUFFIN RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1013
Mailing Address - Country:US
Mailing Address - Phone:858-292-1144
Mailing Address - Fax:858-268-5145
Practice Address - Street 1:5776 RUFFIN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1013
Practice Address - Country:US
Practice Address - Phone:858-292-1144
Practice Address - Fax:858-268-5145
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17138174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90478Medicare UPIN