Healthcare Provider Details

I. General information

NPI: 1912831512
Provider Name (Legal Business Name): ELIZABETH TARZON MA, CAPS, CMC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 CENTRAL AVE APT 10
ALAMEDA CA
94501-3877
US

IV. Provider business mailing address

732 CENTRAL AVE APT 10
ALAMEDA CA
94501-3877
US

V. Phone/Fax

Practice location:
  • Phone: 510-775-3464
  • Fax:
Mailing address:
  • Phone: 510-775-3464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberC-4067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: