Provider Demographics
NPI:1669687687
Name:PRICE, ELIZABETH PHILLIPS (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PHILLIPS
Last Name:PRICE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:YALE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2340 CLAY ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1932
Mailing Address - Country:US
Mailing Address - Phone:415-600-1051
Mailing Address - Fax:415-474-0703
Practice Address - Street 1:2340 CLAY ST
Practice Address - Street 2:SUITE 114
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1932
Practice Address - Country:US
Practice Address - Phone:415-600-1051
Practice Address - Fax:415-474-0703
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17746363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP96836Medicare UPIN