Healthcare Provider Details

I. General information

NPI: 1457442089
Provider Name (Legal Business Name): ELIZABETH FLORENTINO BUSELLI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4165 BLACKHAWK PLAZA CIR #250
DANVILLE CA
94506-4904
US

IV. Provider business mailing address

4165 BLACKHAWK PLAZA CIR #250
DANVILLE CA
94506-4904
US

V. Phone/Fax

Practice location:
  • Phone: 925-736-8510
  • Fax: 925-736-2491
Mailing address:
  • Phone: 925-736-8510
  • Fax: 925-736-2491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number478730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: