Provider Demographics
NPI:1568079333
Name:PADDOCK, ELIZABETH JAYNE
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JAYNE
Last Name:PADDOCK
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 1:7334 W OHIO AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4986
Mailing Address - Country:US
Mailing Address - Phone:714-299-8945
Mailing Address - Fax:
Practice Address - Street 1:7334 W OHIO AVE APT 208
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4986
Practice Address - Country:US
Practice Address - Phone:714-299-8945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program