Individual
DR. ELAINE LOUISE PICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3031 TELEGRAPH AVE STE 241, BERKELEY, CA 94705-2053
(510) 558-8074
(510) 923-0378
Mailing address
PO BOX 20059, OAKLAND, CA 94620-0059
(510) 558-8074
(510) 923-0378
Taxonomy
Speciality
Code
Description
License number
State
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
G83371
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G833710
MEDI-CAL/MEDICAID NUMBER
CA
Enumeration date
07/23/2006
Last updated
07/09/2007
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