Provider Demographics
NPI:1366214405
Name:PESSOA, ELISABETE
Entity type:Individual
Prefix:
First Name:ELISABETE
Middle Name:
Last Name:PESSOA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BAYVIEW TER
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2424
Mailing Address - Country:US
Mailing Address - Phone:707-254-5336
Mailing Address - Fax:
Practice Address - Street 1:4 BAYVIEW TER
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2424
Practice Address - Country:US
Practice Address - Phone:707-254-5336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula