MEDICARE: ELIZABETH DENNIS

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
1	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D65430304	OTHER	CA	DRIVERLICENSE

General Provider Information

NPI Number	:	1093874521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH DENNIS

Provider Business Mailing Address
First Line	:	6410 CONLON AVE
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-1613
Country	:	US
Telephone Number	:	510-232-5612
Fax Number	:

Provider Business Practice Location Address
First Line	:	2166 HAYES ST
Second Line	:	303
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94117-1033
Country	:	US
Telephone Number	:	415-379-7201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/08/2007

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Directions to “ ELIZABETH DENNIS ” Practice Location

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