Healthcare Provider Details

I. General information

NPI: 1215095864
Provider Name (Legal Business Name): ELIZABETH ANNE TRACHTENBERG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST CHILDRENS HOSPITAL OAKLAND, BLMRB STE 204
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

2960 BENVENUE AVE
BERKELEY CA
94705-2231
US

V. Phone/Fax

Practice location:
  • Phone: 510-450-7685
  • Fax: 510-450-5692
Mailing address:
  • Phone: 510-665-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License NumberDRK24
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: