Healthcare Provider Details

I. General information

NPI: 1891481826
Provider Name (Legal Business Name): ELANZA WELLNESS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 BUSH ST
SAN FRANCISCO CA
94115-3106
US

IV. Provider business mailing address

FLAT 19, 31 INVERNESS TERRACE
LONDON ENGLAND
W2 3JR
GB

V. Phone/Fax

Practice location:
  • Phone: 707-339-9378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY HAWKINS
Title or Position: CEO
Credential:
Phone: 707-339-9378