Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 5119 | CA |
Y | 222Z00000X | Podiatrist | 5119 | CA |
N | 213ES0131X | Foot Surgery | PO 2990 | FL |
NPI | 1013971621 |
---|---|
Provider Name | Dr. Elizabeth Anne Reilly |
First Address | Palo Alto, CA 94305-2200 |
Second Address | Palo Alto, CA 94305-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 18/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201678195 0002 | CIGNA (01) | |
201678195 33444 A001 | TRICARE (01) | |
65865 | BCBS OF FL (01) | FL |
U68007 | (02) |