MEDICARE: MALIA LEANNE JUSTICE HEALTH SERVICES TECH

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
1	247200000X	Other Technician		CA

General Provider Information

NPI Number	:	1801932033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALIA LEANNE JUSTICE HEALTH SERVICES TECH

Provider Business Mailing Address
First Line	:	1 YERBA BUENA ISLAND ROAD
Second Line	:	CGC ASPEN
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94130
Country	:	US
Telephone Number	:	415-399-3590
Fax Number	:	415-399-3577

Provider Business Practice Location Address
First Line	:	1 YERBA BUENA RD
Second Line	:	CGC ASPEN
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94130-1527
Country	:	US
Telephone Number	:	415-399-3590
Fax Number	:	415-399-3577

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/26/2007

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