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General NPI Number Information
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NPI Number | 1104518570
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Entity Type | Individual
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Provider Name | ELIZABETH GRUBER
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Gender | Female
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 1466 LINCOLN AVE
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2021
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Country | US
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Telephone | 502-702-9929
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Fax |
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Provider Business Mailing Address
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Address Line | 18 2ND ST UNIT A
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City | SAUSALITO
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State | CA
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Zip | 94965-2542
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Country | US
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Telephone | 502-702-9929
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APN.0998727-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95033940
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License Number State | CA
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