Healthcare Provider Details

I. General information

NPI: 1235337148
Provider Name (Legal Business Name): ELIZABETH ANNE BACA MD, MPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

2190 GROVE ST APT 2
SAN FRANCISCO CA
94117-1024
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1000
  • Fax:
Mailing address:
  • Phone: 415-310-2563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number100241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: