Healthcare Provider Details

I. General information

NPI: 1609196831
Provider Name (Legal Business Name): ELIZABETH ROSE STEWART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 S VAN NESS AVE APT 21
SAN FRANCISCO CA
94110-7312
US

IV. Provider business mailing address

566 S VAN NESS AVE APT 21
SAN FRANCISCO CA
94110-7312
US

V. Phone/Fax

Practice location:
  • Phone: 510-499-5558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA119430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: