Healthcare Provider Details

I. General information

NPI: 1609721232
Provider Name (Legal Business Name): ELIZABETH ANNANDALE KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CROWN POINT CIR STE 125
GRASS VALLEY CA
95945-9538
US

IV. Provider business mailing address

16573 AUBURN RD
GRASS VALLEY CA
95949-8762
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-5440
  • Fax:
Mailing address:
  • Phone: 530-273-0631
  • Fax: 916-504-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: