MEDICARE: DR. ELISA E WASHBURN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	20A10454	CA
2	207Q00000X	Family Medicine Physician	20A10454	CA

General Provider Information

NPI Number	:	1205076379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELISA E WASHBURN DO

Provider Business Mailing Address
First Line	:	1441 LIBERTY ST
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96001-0811
Country	:	US
Telephone Number	:	530-226-1753
Fax Number	:	530-224-2723

Provider Business Practice Location Address
First Line	:	1665 DOMINICAN WAY STE 224
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95065-1515
Country	:	US
Telephone Number	:	831-246-8772
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2009
Last Update Date	:	02/19/2026

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