Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | G64542 | CA |
N | 208D00000X | General Practice Physician | G64542 | CA |
NPI | 1316966815 |
---|---|
Provider Name | Dr. Elyse Rae Eisenberg |
First Address | Oakland, CA 94611-2802 |
Second Address | Santa Rosa, CA 95405-6710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 13/01/2015 |