Healthcare Provider Details

I. General information

NPI: 1669053328
Provider Name (Legal Business Name): ANNALIESE GABRIELLE ELAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 DARLENE CT
ALAMO CA
94507-1855
US

IV. Provider business mailing address

28 DARLENE CT
ALAMO CA
94507-1855
US

V. Phone/Fax

Practice location:
  • Phone: 925-588-9917
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number343336
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: