Healthcare Provider Details

I. General information

NPI: 1871336008
Provider Name (Legal Business Name): TWEETY DOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2024
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 89TH ST
DALY CITY CA
94015-1802
US

IV. Provider business mailing address

375 89TH ST
DALY CITY CA
94015-1802
US

V. Phone/Fax

Practice location:
  • Phone: 650-301-8650
  • Fax:
Mailing address:
  • Phone: 650-301-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number159241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: