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NPI Code Detail

MEDICARE: MR. NORMAN MATHIS

MEDICARE: MR. NORMAN MATHIS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
130454OTHERCAINSYST STAFF ID NUMBER

General Provider Information

NPI Number : 1548305485
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NORMAN MATHIS
Provider Business Mailing Address
First Line : 940 HAYES ST
Second Line : APT. D
City : SAN FRANCISCO
State : CA
Zip : 94117-2513
Country : US
Telephone Number : 415-921-5562
Fax Number :
Provider Business Practice Location Address
First Line : 1601 QUESADA AVE
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94124-2334
Country : US
Telephone Number : 415-822-5945
Fax Number : 415-822-5943
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2007
Last Update Date : 07/08/2007

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