MEDICARE: DR. ELEONOR LOYOLA GRIFFITH D.O.

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	12052	CA
2	207Q00000X	Family Medicine Physician	20A12052	CA

General Provider Information

NPI Number	:	1306079660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELEONOR LOYOLA GRIFFITH D.O.

Provider Business Mailing Address
First Line	:	1611 CREEKSIDE DR STE 101
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-3490
Country	:	US
Telephone Number	:	916-984-9004
Fax Number	:	187-788-8030

Provider Business Practice Location Address
First Line	:	1611 CREEKSIDE DR STE 101
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-3490
Country	:	US
Telephone Number	:	916-984-9004
Fax Number	:	187-788-8030

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

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	07/24/2024

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