Provider Demographics
NPI:1780610196
Name:HYDEN, ELIZABETH C (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:HYDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27800 MEDICAL CENTER RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6410
Mailing Address - Country:US
Mailing Address - Phone:949-364-9120
Mailing Address - Fax:
Practice Address - Street 1:27800 MEDICAL CENTER RD
Practice Address - Street 2:SUITE 160
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6410
Practice Address - Country:US
Practice Address - Phone:949-364-9120
Practice Address - Fax:949-364-8465
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG574562085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G574560Medicaid
CA00G574560Medicaid