| Doctor Name: | DR. ELISA DULCINEA O'HERN |
| NPI Number: | 1588874911 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 24078 |
| Business Practice Address: | 9040 Fitzsimmons Dr Mamc Pediatric Clinic Tacoma, WA - 984311100 |
| Business Phone Number: | 2539683066 |
| Business Fax Number: | |
| Mailing Address: | 11710 141st St E, PUYALLUP |
| State: | WA |
| Postal Code: | 983743975 |
| Phone Number: | 2539683066 |
| Fax Number: | |
| NPI Enumeration Date: | 05/23/2007 |
| NPI Last Update Date: | 09/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 24078 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NE |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |