Healthcare Provider Details

I. General information

NPI: 1699287383
Provider Name (Legal Business Name): ELIZABETH LIEPPMAN ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELLY MICHELLE ND

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 SORRENTO VALLEY BLVD STE A
SAN DIEGO CA
92121-1423
US

IV. Provider business mailing address

4125 SORRENTO VALLEY BLVD STE A
SAN DIEGO CA
92121-1423
US

V. Phone/Fax

Practice location:
  • Phone: 858-531-5279
  • Fax:
Mailing address:
  • Phone: 858-531-5279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND934
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: