Provider Demographics
NPI:1033374681
Name:RETAILLEAU, ELIZABETH LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LOUISE
Last Name:RETAILLEAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:LOUISE
Other - Last Name:RETAILLEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3700 24TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3904
Mailing Address - Country:US
Mailing Address - Phone:415-641-1019
Mailing Address - Fax:415-826-1308
Practice Address - Street 1:3700 24TH STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114
Practice Address - Country:US
Practice Address - Phone:415-641-1019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103728208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics