Provider Demographics
NPI:1699092338
Name:WALDMAN, ELIZABETH ANNE (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2875 CLIFFRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2116
Mailing Address - Country:US
Mailing Address - Phone:304-646-6583
Mailing Address - Fax:
Practice Address - Street 1:17140 BERNARDO CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2000
Practice Address - Country:US
Practice Address - Phone:833-783-7411
Practice Address - Fax:858-716-8101
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136012084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry