Healthcare Provider Details

I. General information

NPI: 1740258003
Provider Name (Legal Business Name): ELIZABETH HECHAVARRIA YEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH HECHAVARRIA M.D.

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-0110
US

IV. Provider business mailing address

500 PAMASSUS AVE, MU-4E BOX 0136
SAN FRANCISCO CA
94143-0136
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-5892
  • Fax: 415-476-1343
Mailing address:
  • Phone: 415-476-5892
  • Fax: 415-476-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number220343
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number220343
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberC55108
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC55108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: