| Doctor Name: | MR. AMY CLAIRE ELLSWORTH |
| NPI Number: | 1174711436 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C,MMS |
| License Number: | PA19249 |
| Business Practice Address: | 12865 Pointe Del Mar Way Suite #160 Del Mar, CA - 920143860 |
| Business Phone Number: | 8583507546 |
| Business Fax Number: | 8583508282 |
| Mailing Address: | 12865 Pointe Del Mar Way, Suite #160 DEL MAR |
| State: | CA |
| Postal Code: | 920143860 |
| Phone Number: | 8583507546 |
| Fax Number: | 8583508282 |
| NPI Enumeration Date: | 10/11/2007 |
| NPI Last Update Date: | 10/11/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA19249 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |