Healthcare Provider Details

I. General information

NPI: 1255697611
Provider Name (Legal Business Name): ELIZABETH LINDLEY WADHWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 16TH ST FL 4 BOX 0434
SAN FRANCISCO CA
94158-2545
US

IV. Provider business mailing address

1501 KINGS HIGHWAY ATTN: LEISA OGLESBY (RM. 1-201)
SHREVEPORT LA
71103-4228
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-3874
  • Fax:
Mailing address:
  • Phone: 318-675-4881
  • Fax: 318-675-5069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number308923
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: