Healthcare Provider Details

I. General information

NPI: 1740286749
Provider Name (Legal Business Name): ELISABETH A BOSSINGHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. ELISABETH A HOAG

II. Dates (important events)

Enumeration Date: 06/23/2005
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:
Title or Position:
Credential:
Phone: