Individual
ELIZABETH KINE MCINTYRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
133 W SANTA CLARA ST, VENTURA, CA 93001-2543
(805) 641-5600
(805) 641-5677
Mailing address
133 W SANTA CLARA ST, VENTURA, CA 93001-2543
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
56777
CA
363AS0400X
Surgical Physician Assistant
Primary
56777
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5677
STATE LICENSE
CA
Enumeration date
05/03/2019
Last updated
07/14/2023
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