MEDICARE: ELIZABETH R DEOLIVEIRA MD

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	2080P0202X	Pediatric Cardiology Physician	C50168	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265414833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH R DEOLIVEIRA MD

Provider Business Mailing Address
First Line	:	50 BELLEFONTAINE ST
Second Line	:	STE 405
City	:	PASADENA
State	:	CA
Zip	:	91105-3132
Country	:	US
Telephone Number	:	626-796-9259
Fax Number	:	626-449-8560

Provider Business Practice Location Address
First Line	:	50 BELLEFONTAINE ST
Second Line	:	STE 405
City	:	PASADENA
State	:	CA
Zip	:	91105-3132
Country	:	US
Telephone Number	:	626-796-9259
Fax Number	:	626-449-8560

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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