Provider Demographics
NPI: | 1407632565 |
---|---|
Name: | ELIZABETH SWENSON, M.D., P.C. |
Entity Type: | Organization |
Organization Name: | ELIZABETH SWENSON, M.D., P.C. |
Other - Org Name: | TEAL MEDICAL GROUP OF CALIFORNIA, P.C. |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | HEAD OF OPERATIONS |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | ALEX |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MILLIE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 415-294-0775 |
Mailing Address - Street 1: | 1012 TORNEY AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN FRANCISCO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94129-1704 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 415-294-0775 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1012 TORNEY AVE |
Practice Address - Street 2: | |
Practice Address - City: | SAN FRANCISCO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94129-1704 |
Practice Address - Country: | US |
Practice Address - Phone: | 415-294-0775 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-09-05 |
Last Update Date: | 2023-11-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Single Specialty |