Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC22847 | CA |
NPI | 1669522439 |
---|---|
Provider Name | Dr. Elizabeth Serra |
First Address | San Francisco, CA 94110-2467 |
Second Address | San Francisco, CA 94110-2467 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |