Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | G078244 | CA |
NPI | 1063632420 |
---|---|
Provider Name | Elizabeth Griffin Hedelman |
First Address | Berkeley, CA 94720-4303 |
Second Address | Berkeley, CA 94720-4303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |