Provider Demographics
NPI:1093481020
Name:RINCON, ELIZABETH (R1433030621)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:RINCON
Suffix:
Gender:F
Credentials:R1433030621
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 HARRIER PL
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7673
Mailing Address - Country:US
Mailing Address - Phone:408-202-8498
Mailing Address - Fax:
Practice Address - Street 1:9500 MALECH RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138
Practice Address - Country:US
Practice Address - Phone:408-281-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)