Healthcare Provider Details

I. General information

NPI: 1811434947
Provider Name (Legal Business Name): ELIZA CONROY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2642 31ST AVE
SAN FRANCISCO CA
94116-2936
US

IV. Provider business mailing address

2642 31ST AVE
SAN FRANCISCO CA
94116-2936
US

V. Phone/Fax

Practice location:
  • Phone: 415-519-0629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: