Provider Demographics
NPI:1376149799
Name:RILEY, ELIZABETH MARSHALL (LAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARSHALL
Last Name:RILEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-7141
Mailing Address - Country:US
Mailing Address - Phone:408-354-0966
Mailing Address - Fax:
Practice Address - Street 1:10 JACKSON ST
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-7141
Practice Address - Country:US
Practice Address - Phone:408-354-0966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist