Provider Demographics
NPI:1952693756
Name:KANN, ELIZABETH GARAMENDI (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GARAMENDI
Last Name:KANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MERLE
Other - Middle Name:ELIZABETH
Other - Last Name:GARAMENDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:855-771-0335
Mailing Address - Fax:
Practice Address - Street 1:8170 LAGUNA BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7901
Practice Address - Country:US
Practice Address - Phone:916-691-5900
Practice Address - Fax:916-691-5923
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA127067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program