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General NPI Number Information
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NPI Number | 1346690096
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Entity Type | Individual
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Provider Name | ELISE B. ASGHAR MD
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Gender | Female
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 3883 AIRWAY DR STE 165
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City | SANTA ROSA
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State | CA
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Zip | 95403-1675
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Country | US
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Telephone | 707-521-7799
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Fax | 707-573-5431
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Provider Business Mailing Address
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Address Line | PO BOX 276950
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City | SACRAMENTO
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State | CA
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Zip | 95827-6950
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Country | US
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Telephone | 707-521-7799
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Fax | 707-573-5431
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | A153661
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License Number State | CA
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