Healthcare Provider Details

I. General information

NPI: 1174588529
Provider Name (Legal Business Name): ELIZABETH TRACY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19671 BEACH BLVD STE 201
HUNTINGTON BEACH CA
92648-5903
US

IV. Provider business mailing address

19671 BEACH BLVD STE 201
HUNTINGTON BEACH CA
92648-5903
US

V. Phone/Fax

Practice location:
  • Phone: 714-740-7597
  • Fax: 714-740-7672
Mailing address:
  • Phone: 714-740-7597
  • Fax: 714-740-7672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG75852
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberG75852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: