Healthcare Provider Details

I. General information

NPI: 1447719331
Provider Name (Legal Business Name): ELIZABETH MARIE RISNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LA CASA VIA STE 110
WALNUT CREEK CA
94598-3047
US

IV. Provider business mailing address

8132 WALNUT GROVE CT
OAKLEY CA
94561
US

V. Phone/Fax

Practice location:
  • Phone: 925-476-5379
  • Fax:
Mailing address:
  • Phone: 650-740-5137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number39532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: