Provider Demographics
NPI:1235199563
Name:HUGHES, ELISE NOEL (MD)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:NOEL
Last Name:HUGHES
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:C/O UCSC STUDENT HEALTH SERVICES
Mailing Address - Street 2:1156 HIGH ST
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95064
Mailing Address - Country:US
Mailing Address - Phone:208-467-4431
Mailing Address - Fax:208-467-4684
Practice Address - Street 1:C/O UCSC STUDENT HEALTH SERVICES
Practice Address - Street 2:1156 HIGH ST
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95064
Practice Address - Country:US
Practice Address - Phone:208-466-7869
Practice Address - Fax:208-466-5359
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6798207Q00000X
CAC54156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003737600Medicaid
1133761Medicare ID - Type UnspecifiedCIGNA