Healthcare Provider Details

I. General information

NPI: 1578246039
Provider Name (Legal Business Name): ELIZABETH JULIA ENSLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA ENSLER

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7666 STOCKTON AVE
EL CERRITO CA
94530-3036
US

IV. Provider business mailing address

7666 STOCKTON AVE
EL CERRITO CA
94530-3036
US

V. Phone/Fax

Practice location:
  • Phone: 510-725-5895
  • Fax:
Mailing address:
  • Phone: 510-725-5895
  • 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: