Provider Demographics
NPI:1447564786
Name:FERDINAND, ELISKA MARIE
Entity Type:Individual
Prefix:
First Name:ELISKA
Middle Name:MARIE
Last Name:FERDINAND
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:PO BOX 882692
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94188-2692
Mailing Address - Country:US
Mailing Address - Phone:707-246-7949
Mailing Address - Fax:
Practice Address - Street 1:375 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1221
Practice Address - Country:US
Practice Address - Phone:415-753-7784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program