Provider Demographics
NPI:1033283486
Name:SELANDIA, ELIZABETH (LAC, OMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:SELANDIA
Suffix:
Gender:F
Credentials:LAC, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2636
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-0636
Mailing Address - Country:US
Mailing Address - Phone:510-739-6306
Mailing Address - Fax:
Practice Address - Street 1:HOUSECALLS ONLY
Practice Address - Street 2:
Practice Address - City:EAST BAY
Practice Address - State:CA
Practice Address - Zip Code:94536
Practice Address - Country:US
Practice Address - Phone:510-739-6306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 2946171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist