Healthcare Provider Details

I. General information

NPI: 1215012505
Provider Name (Legal Business Name): ELIZABETH ANN PLATZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

IV. Provider business mailing address

11391 RELAJANTE WAY
FRESNO CA
93730-8855
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-6700
  • Fax: 559-353-6710
Mailing address:
  • Phone: 843-810-8729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberC55758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: