Provider Demographics
NPI:1265702898
Name:DOSSANTOS, ELIZABETH (DO)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:DOSSANTOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10608 N TRADEMARK PKWY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5934
Mailing Address - Country:US
Mailing Address - Phone:916-709-5540
Mailing Address - Fax:
Practice Address - Street 1:10608 N TRADEMARK PKWY
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5934
Practice Address - Country:US
Practice Address - Phone:916-709-5540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8625207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine