Healthcare Provider Details

I. General information

NPI: 1700319019
Provider Name (Legal Business Name): ELIZABETH ADLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

2111 EASTON DR
BURLINGAME CA
94010-5635
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1528
  • Fax:
Mailing address:
  • Phone: 650-302-2949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: