Healthcare Provider Details

I. General information

NPI: 1578542676
Provider Name (Legal Business Name): ELISE F ATKINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112A SOQUEL AVE
SANTA CRUZ CA
95062-1401
US

IV. Provider business mailing address

849 ALMAR AVE STE C-177
SANTA CRUZ CA
95060-5875
US

V. Phone/Fax

Practice location:
  • Phone: 831-400-5665
  • Fax: 831-346-4851
Mailing address:
  • Phone: 831-400-5665
  • Fax: 831-346-4851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License NumberA87393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: