Healthcare Provider Details

I. General information

NPI: 1003183708
Provider Name (Legal Business Name): ELISABETH LESLIE GOLDSTEIN RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 MISSION ST
SAN FRANCISCO CA
94103-1519
US

IV. Provider business mailing address

1171 MISSION ST
SAN FRANCISCO CA
94103-1519
US

V. Phone/Fax

Practice location:
  • Phone: 415-734-4231
  • Fax: 415-734-4218
Mailing address:
  • Phone: 415-734-4231
  • Fax: 415-734-4218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number730174
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number19981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: