Organization
ELAINE L PICO, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELAINE L PICO M.D. (OWNER)
(510) 558-8074
Entity
Organization
Contact information
Practice address
2825 INTERNATIONAL BLVD, ROOM RC121, OAKLAND, CA 94601-1543
(510) 558-8074
Mailing address
PO BOX 20059, OAKLAND, CA 94620-0059
(510) 558-8074
Taxonomy
Speciality
Code
Description
License number
State
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
G83371
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMS162039
—
CA
Enumeration date
04/15/2008
Last updated
04/15/2008
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