Healthcare Provider Details

I. General information

NPI: 1346690096
Provider Name (Legal Business Name): ELISE B. ASGHAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISE M. BRITT

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 AIRWAY DR STE 165
SANTA ROSA CA
95403-1675
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-7799
  • Fax: 707-573-5431
Mailing address:
  • Phone: 707-521-7799
  • Fax: 707-573-5431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA153661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: