Healthcare Provider Details

I. General information

NPI: 1508979923
Provider Name (Legal Business Name): ELIZABETH SUZANNE CULHANE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DOYLE PARK DR SUITE 100
SANTA ROSA CA
95405-4558
US

IV. Provider business mailing address

500 DOYLE PARK DR SUITE 100
SANTA ROSA CA
95405-4558
US

V. Phone/Fax

Practice location:
  • Phone: 707-544-6090
  • Fax: 707-544-2389
Mailing address:
  • Phone: 707-544-6090
  • Fax: 707-544-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG74888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: