Healthcare Provider Details

I. General information

NPI: 1346550902
Provider Name (Legal Business Name): ELIZABETH A. HERB, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 SOUTHAMPTON DR.
PALO ALTO CA
94303
US

IV. Provider business mailing address

2625 MIDDLEFIELD RD 593
PALO ALTO CA
94306
US

V. Phone/Fax

Practice location:
  • Phone: 650-328-3707
  • Fax:
Mailing address:
  • Phone: 650-328-3707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG25524
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberG25524
License Number StateCA

VIII. Authorized Official

Name: DR. ELIZABETH A HERB
Title or Position: PRESIDENT
Credential: M.D.
Phone: 650-328-3707