Provider Demographics
NPI:1114083623
Name:BIAS, ELIZABETH BLAIR
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BLAIR
Last Name:BIAS
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 1:410 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2526
Mailing Address - Country:US
Mailing Address - Phone:925-275-2797
Mailing Address - Fax:
Practice Address - Street 1:2819 CROW CANYON RD
Practice Address - Street 2:SUITE 219 A
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1655
Practice Address - Country:US
Practice Address - Phone:925-275-2797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16873103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL168730Medicare ID - Type UnspecifiedNHIC