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General NPI Number Information
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NPI Number | 1033345244
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Entity Type | Individual
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Provider Name | ELISEO AMEZCUA MA
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Gender | Male
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Dates
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Enumeration Date | 06/02/2009
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 1950 ALAMEDA DE LAS PULGAS
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City | SAN MATEO
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State | CA
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Zip | 94403-1222
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Country | US
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Telephone | 650-573-2302
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Fax |
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Provider Business Mailing Address
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Address Line | 310 HARBOR BLVD BLDG C
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City | BELMONT
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State | CA
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Zip | 94002-4018
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Country | US
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Telephone | 650-372-3208
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Fax | 650-802-6440
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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