Healthcare Provider Details

I. General information

NPI: 1245817311
Provider Name (Legal Business Name): ELIZABETH FLAHERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH MAHAN

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 TYDD ST
EUREKA CA
95501-1284
US

IV. Provider business mailing address

1275 8TH ST
ARCATA CA
95521-5770
US

V. Phone/Fax

Practice location:
  • Phone: 707-441-1624
  • Fax: 707-441-1253
Mailing address:
  • Phone: 707-826-8633
  • Fax: 707-826-6838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number197038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: