Healthcare Provider Details

I. General information

NPI: 1255358800
Provider Name (Legal Business Name): ELISABETH A. BOSSINGHAM, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 S COURT ST SUITE F
VISALIA CA
93277-5469
US

IV. Provider business mailing address

1827 S COURT ST SUITE F
VISALIA CA
93277-5469
US

V. Phone/Fax

Practice location:
  • Phone: 559-622-0800
  • Fax: 559-622-0801
Mailing address:
  • Phone: 559-622-0800
  • Fax: 559-622-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG69388
License Number StateCA

VIII. Authorized Official

Name: DR. ELISABETH A. BOSSINGHAM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-622-0800