Healthcare Provider Details

I. General information

NPI: 1366182016
Provider Name (Legal Business Name): ELIZABETH PORTER DIXON PA-C, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 01/01/2025
Certification Date: 01/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 CALIFORNIA ST
MOUNTAIN VIEW CA
94040-1397
US

IV. Provider business mailing address

542 BRANNAN ST APT 311
SAN FRANCISCO CA
94107-5503
US

V. Phone/Fax

Practice location:
  • Phone: 650-948-0807
  • Fax:
Mailing address:
  • Phone: 586-419-4816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: