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NPI Code Detail

MEDICARE: MS. DOMINIQUE ANNE LEGNITTO PACKARD

MEDICARE: MS. DOMINIQUE ANNE LEGNITTO PACKARD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramCA

General Provider Information

NPI Number : 1215584214
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DOMINIQUE ANNE LEGNITTO PACKARD
Provider Business Mailing Address
First Line : 615 HYDE ST APT 24
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94109-7242
Country : US
Telephone Number : 360-259-0926
Fax Number :
Provider Business Practice Location Address
First Line : 564 6TH ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94103-4708
Country : US
Telephone Number : 415-553-1706
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2019
Last Update Date : 08/23/2019

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