| Doctor Name: | DR. ELYSE RAE EISENBERG |
| NPI Number: | 1316966815 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | G64542 |
| Business Practice Address: | 725 Farmers Ln Ste 10 Santa Rosa, CA - 954056710 |
| Business Phone Number: | 7075233375 |
| Business Fax Number: | 8668700815 |
| Mailing Address: | 6114 La Salle Ave, 438 OAKLAND |
| State: | CA |
| Postal Code: | 946112802 |
| Phone Number: | 7075233375 |
| Fax Number: | 8668700815 |
| NPI Enumeration Date: | 07/18/2006 |
| NPI Last Update Date: | 01/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | G64542 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |