Healthcare Provider Details

I. General information

NPI: 1811936800
Provider Name (Legal Business Name): ELIZABETH KATHLEEN QUADRACCIA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH K MILLER PA

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BALDWIN AVE
SAN MATEO CA
94401-3915
US

IV. Provider business mailing address

370 GOLDEN GRASS DR STE 400
ALAMO CA
94507-2789
US

V. Phone/Fax

Practice location:
  • Phone: 650-579-6581
  • Fax:
Mailing address:
  • Phone: 650-995-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-00390
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006414
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: