Healthcare Provider Details

I. General information

NPI: 1265689350
Provider Name (Legal Business Name): ELIZABETH GULAIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1082 TRESTLE GLEN RD
OAKLAND CA
94610-2547
US

IV. Provider business mailing address

1082 TRESTLE GLEN RD
OAKLAND CA
94610-2547
US

V. Phone/Fax

Practice location:
  • Phone: 650-758-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: