Provider Demographics
NPI:1366548232
Name:PUSEY, ELIZABETH J (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:J
Last Name:PUSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:J
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:361 HOSPITAL RD
Mailing Address - Street 2:SUITE 528
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3522
Mailing Address - Country:US
Mailing Address - Phone:949-645-2321
Mailing Address - Fax:949-645-2039
Practice Address - Street 1:361 HOSPITAL RD
Practice Address - Street 2:STE 528
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3522
Practice Address - Country:US
Practice Address - Phone:949-645-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50236174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G502361Medicaid
CAG50236Medicare PIN
CA00G502361Medicaid