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NPI Code Detail

MEDICARE: ELOISE GERKEN

MEDICARE: ELOISE GERKEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist120666CA

General Provider Information

NPI Number : 1043777410
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELOISE GERKEN
Provider Business Mailing Address
First Line : 744 EMPIRE ST STE 120
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-5550
Country : US
Telephone Number : 510-934-5543
Fax Number :
Provider Business Practice Location Address
First Line : 744 EMPIRE ST STE 120
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-5550
Country : US
Telephone Number : 707-440-9923
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2019
Last Update Date : 02/13/2025

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Directions to “ ELOISE GERKEN ” Practice Location

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