Provider Demographics
NPI:1275729360
Name:WASSERBERG, ELYSSA (DC)
Entity Type:Individual
Prefix:
First Name:ELYSSA
Middle Name:
Last Name:WASSERBERG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5080 SPECTRUM DR
Mailing Address - Street 2:SUITE 1200 WEST
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4648
Mailing Address - Country:US
Mailing Address - Phone:972-725-6673
Mailing Address - Fax:214-775-4406
Practice Address - Street 1:384 EMBARCADERO W
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3731
Practice Address - Country:US
Practice Address - Phone:510-465-9565
Practice Address - Fax:510-465-3840
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA248942083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine