Healthcare Provider Details

I. General information

NPI: 1093498644
Provider Name (Legal Business Name): ELIZA PRICE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 HARLAN ST
WHEAT RIDGE CO
80033-7427
US

IV. Provider business mailing address

3751 HARLAN ST
WHEAT RIDGE CO
80033-7427
US

V. Phone/Fax

Practice location:
  • Phone: 203-536-6611
  • Fax:
Mailing address:
  • Phone: 203-536-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86297797
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: