Provider Demographics
NPI:1770949596
Name:SPENCE, ELIZABETH (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SPENCE
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 1:2776 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2613
Mailing Address - Country:US
Mailing Address - Phone:916-468-2656
Mailing Address - Fax:
Practice Address - Street 1:12555 W JEFFERSON BLVD STE 301
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-7032
Practice Address - Country:US
Practice Address - Phone:424-443-5555
Practice Address - Fax:424-443-5550
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine