Healthcare Provider Details

I. General information

NPI: 1801830575
Provider Name (Legal Business Name): ELIZABETH S POWELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLBY ST. STE. 304
BERKELEY CA
94705
US

IV. Provider business mailing address

3000 COLBY ST. STE. 304
BERKELEY CA
94705
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-7533
  • Fax: 510-848-0105
Mailing address:
  • Phone: 510-848-7533
  • Fax: 510-848-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG48667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: