Individual
CHANTAL ELIZAGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
50 ACACIA AVE, SAN RAFAEL, CA 94901-2230
(415) 457-4440
Mailing address
643 S ORANGE DR, LOS ANGELES, CA 90036-3507
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
60625
CA
Other
Enumeration date
09/08/2020
Last updated
02/10/2022
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