MEDICARE: ELEONOR LOYOLA GRIFFITH, DO, PC

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	208D00000X	General Practice Physician	A0A12052	CA

General Provider Information

NPI Number	:	1427449339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEONOR LOYOLA GRIFFITH, DO, PC

Provider Business Mailing Address
First Line	:	1611 CREEKSIDE DR STE 101
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-3490
Country	:	US
Telephone Number	:	916-984-9004
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 CREEKSIDE DR STE 101
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-3490
Country	:	US
Telephone Number	:	916-984-9004
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ELEONOR LOYOLA GRIFFITH
Credential	:	D.O.
Telephone Number	:	916-984-9004

Provider Enumeration Date	:	02/13/2015
Last Update Date	:	02/13/2015

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