Healthcare Provider Details

I. General information

NPI: 1871642363
Provider Name (Legal Business Name): ELIZABETH ANN MCAULIFFE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIBBY MCAULIFFE RD

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 KIELY BLVD
SANTA CLARA CA
95051
US

IV. Provider business mailing address

900 KIELY BLVD
SANTA CLARA CA
95051
US

V. Phone/Fax

Practice location:
  • Phone: 408-236-4587
  • Fax:
Mailing address:
  • Phone: 408-236-4587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: