Provider Demographics
NPI:1609135730
Name:ROPER, ELIZABETH JANE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANE
Last Name:ROPER
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 1:140 14TH ST APT 164
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-2159
Mailing Address - Country:US
Mailing Address - Phone:760-877-1125
Mailing Address - Fax:
Practice Address - Street 1:340 RANCHEROS DR STE 166
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2980
Practice Address - Country:US
Practice Address - Phone:760-744-3672
Practice Address - Fax:760-744-6182
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA373790000Medicaid