Provider Demographics
NPI:1902676307
Name:IDE, ELIZABETH AYAKA
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:AYAKA
Last Name:IDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3806
Mailing Address - Country:US
Mailing Address - Phone:408-621-8571
Mailing Address - Fax:
Practice Address - Street 1:729 FILBERT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-2760
Practice Address - Country:US
Practice Address - Phone:415-352-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program