Provider Demographics
NPI:1578246039
Name:ENSLER, ELIZABETH JULIA
Entity Type:Individual
Prefix:
First Name:ELIZABETH JULIA
Middle Name:
Last Name:ENSLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:ENSLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7666 STOCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3036
Mailing Address - Country:US
Mailing Address - Phone:510-725-5895
Mailing Address - Fax:
Practice Address - Street 1:7666 STOCKTON AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3036
Practice Address - Country:US
Practice Address - Phone:510-725-5895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program