Healthcare Provider Details

I. General information

NPI: 1740405026
Provider Name (Legal Business Name): ELIZABETH LAURENA HAWKINS HEGARTY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 LOMBARDI CT STE B
SANTA ROSA CA
95407-5454
US

IV. Provider business mailing address

751 LOMBARDI CT STE B
SANTA ROSA CA
95407-5454
US

V. Phone/Fax

Practice location:
  • Phone: 707-547-2220
  • Fax: 707-547-2229
Mailing address:
  • Phone: 707-547-2220
  • Fax: 707-547-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA97427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: