Provider Demographics
NPI:1669877619
Name:WAITS, ELIZABETH JANE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANE
Last Name:WAITS
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 1:2950 ROUTIER RD SPC 34
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-1924
Mailing Address - Country:US
Mailing Address - Phone:916-429-5788
Mailing Address - Fax:
Practice Address - Street 1:9343 TECH CENTER DR STE 175
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2592
Practice Address - Country:US
Practice Address - Phone:916-490-2413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner