Basic Information
| Provider Information | |||||||||
| NPI: | 1326049115 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRONE | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 EAST STREET | ||||||||
| Address2: | STE 305 | ||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945202066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256861230 | ||||||||
| FaxNumber: | 9256868443 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 LA CASA VIA | ||||||||
| Address2: | STE 210 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945983091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259440351 | ||||||||
| FaxNumber: | 9259441957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2005 | ||||||||
| LastUpdateDate: | 04/04/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | G82134 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | GR0020610 | 05 | CA | MEDICAID | CP2044 | 01 | RAILROAD MEDICARE | OTHER |