Healthcare Provider Details

I. General information

NPI: 1730790072
Provider Name (Legal Business Name): ELIZABETH J TSYBULSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 ADELINE ST STE 120
BERKELEY CA
94703-2579
US

IV. Provider business mailing address

1050 SUMMERSHORE CT
SAN JOSE CA
95122-3368
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-1112
  • Fax:
Mailing address:
  • Phone: 408-480-9802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: