Healthcare Provider Details

I. General information

NPI: 1336043744
Provider Name (Legal Business Name): BRISBANE SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SOLANO ST
BRISBANE CA
94005-1342
US

IV. Provider business mailing address

1 SOLANO ST
BRISBANE CA
94005-1342
US

V. Phone/Fax

Practice location:
  • Phone: 415-467-0550
  • Fax: 415-467-2914
Mailing address:
  • Phone: 415-467-0550
  • Fax: 415-467-2914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: AIDA WONG GAMBA
Title or Position: CHIEF BUSINESS OFFICIAL
Credential:
Phone: 415-604-5287