Provider Demographics
NPI:1538898499
Name:DEAN, ELIZA LORRAINE (CMT)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:LORRAINE
Last Name:DEAN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:ELIZA
Other - Middle Name:LORRAINE
Other - Last Name:DEAN-HYLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMT
Mailing Address - Street 1:2969 HEDGE CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 GRAND AVE STE 301C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4588
Practice Address - Country:US
Practice Address - Phone:510-289-0858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70171R225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist