Provider Demographics
NPI:1336520766
Name:MACINTYRE, ELIZABETH TRESCOT (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TRESCOT
Last Name:MACINTYRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 VISTA WAY STE 130
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4565
Mailing Address - Country:US
Mailing Address - Phone:760-547-1010
Mailing Address - Fax:760-547-1011
Practice Address - Street 1:3605 VISTA WAY STE 130
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4565
Practice Address - Country:US
Practice Address - Phone:760-547-1010
Practice Address - Fax:760-547-1011
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA172352208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program