Provider Demographics
NPI:1841586765
Name:DAUZ, ELIZABETH GISELLE (MA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:GISELLE
Last Name:DAUZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:GISELLE
Other - Last Name:IDANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:5705 RANCHO HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-3401
Mailing Address - Country:US
Mailing Address - Phone:619-274-0181
Mailing Address - Fax:
Practice Address - Street 1:5705 RANCHO HILLS DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-3401
Practice Address - Country:US
Practice Address - Phone:619-274-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38558106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist