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General NPI Number Information
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NPI Number | 1811936800
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Entity Type | Individual
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Provider Name | ELIZABETH KATHLEEN QUADRACCIA PA
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Gender | Female
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 210 BALDWIN AVE
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City | SAN MATEO
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State | CA
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Zip | 94401-3915
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Country | US
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Telephone | 650-579-6581
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Fax |
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Provider Business Mailing Address
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Address Line | 370 GOLDEN GRASS DR STE 400
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City | ALAMO
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State | CA
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Zip | 94507-2789
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Country | US
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Telephone | 650-995-1515
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-00390
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601006414
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License Number State | MI
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