Provider Demographics
NPI:1073796009
Name:BABU, ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BABU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 OUTLET CENTER DR
Mailing Address - Street 2:#159
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0677
Mailing Address - Country:US
Mailing Address - Phone:805-485-2400
Mailing Address - Fax:805-485-3025
Practice Address - Street 1:567 W CHANNEL ISLANDS BLVD
Practice Address - Street 2:#159
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041-2133
Practice Address - Country:US
Practice Address - Phone:516-303-6931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117761207RC0200X
NY252946207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine