MEDICARE: ELISABETH FINNERTY, A PROFESSIONAL CORPORATION

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1700444239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELISABETH FINNERTY, A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2815 PICO BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-1919
Country	:	US
Telephone Number	:	310-314-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 PICO BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-1919
Country	:	US
Telephone Number	:	310-314-2111
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT / FOUNDER
Name	:	ELISABETH FINNERTY
Credential	:
Telephone Number	:	310-625-6226

Provider Enumeration Date	:	05/30/2019
Last Update Date	:	05/30/2019

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