Healthcare Provider Details

I. General information

NPI: 1861703936
Provider Name (Legal Business Name): ELIZABETH JULIA FRIEDMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 UNIVERSITY AVENUE SUITE 150
SAN DIEGO CA
92105-1601
US

IV. Provider business mailing address

2401 GILLHAM RD RM 411
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 619-563-0507
  • Fax: 619-563-0015
Mailing address:
  • Phone: 816-234-2059
  • Fax: 619-563-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA131168
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number2020006519
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number2020006519
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2020006519
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: