Provider Demographics
NPI:1023107364
Name:DATE, ELAINE SATOMI (MD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:SATOMI
Last Name:DATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:363 MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1729
Mailing Address - Country:US
Mailing Address - Phone:650-306-9490
Mailing Address - Fax:650-306-0250
Practice Address - Street 1:363 MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1729
Practice Address - Country:US
Practice Address - Phone:650-306-9490
Practice Address - Fax:650-306-0250
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG50923208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation