Provider Demographics
NPI:1154081404
Name:TAUBODO, ELISE
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:TAUBODO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15315 MAGNOLIA BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1172
Mailing Address - Country:US
Mailing Address - Phone:888-353-8285
Mailing Address - Fax:877-805-3084
Practice Address - Street 1:910 FLORIN RD STE 111
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3569
Practice Address - Country:US
Practice Address - Phone:888-353-8285
Practice Address - Fax:877-805-3084
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst