Healthcare Provider Details

I. General information

NPI: 1811012545
Provider Name (Legal Business Name): CAPITOLA PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4145 CLARES STREET SUITE A
CAPITOLA CA
95010
US

IV. Provider business mailing address

4145 CLARES STREET SUITE A
CAPITOLA CA
95010
US

V. Phone/Fax

Practice location:
  • Phone: 831-476-1933
  • Fax: 831-476-2677
Mailing address:
  • Phone: 831-476-1933
  • Fax: 831-476-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIZABETH BASKERVILLE
Title or Position: OWNER/PEDIATRICIAN
Credential: M.D.
Phone: 831-475-1883