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General NPI Number Information
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NPI Number | 1699092338
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Entity Type | Individual
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Provider Name | ELIZABETH ANNE WALDMAN D.O
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Gender | Female
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 17140 BERNARDO CENTER DR STE 300
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City | SAN DIEGO
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State | CA
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Zip | 92128-2000
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Country | US
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Telephone | 833-783-7411
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Fax | 858-716-8101
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Provider Business Mailing Address
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Address Line | 2875 CLIFFRIDGE CT
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City | LA JOLLA
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State | CA
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Zip | 92037-2116
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Country | US
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Telephone | 304-646-6583
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 13601
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 13601
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License Number State | CA
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