Healthcare Provider Details

I. General information

NPI: 1619639721
Provider Name (Legal Business Name): JONATHAN FAERSTEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date: 07/11/2023
Reactivation Date: 08/23/2023

III. Provider practice location address

1918 UNIVERSITY AVE
BERKELEY CA
94704-3264
US

IV. Provider business mailing address

1038 POST ST
SAN FRANCISCO CA
94109-5603
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-9716
  • Fax:
Mailing address:
  • Phone: 415-775-2636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: