Healthcare Provider Details

I. General information

NPI: 1861574428
Provider Name (Legal Business Name): ROBERT S. FERRETTI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 SIR FRANCIS DRAKE BLVD 302
GREENBRAE CA
94904-1712
US

IV. Provider business mailing address

599 SIR FRANCIS DRAKE BLVD 302
GREENBRAE CA
94904-1712
US

V. Phone/Fax

Practice location:
  • Phone: 415-292-9528
  • Fax: 415-461-4971
Mailing address:
  • Phone: 415-292-9528
  • Fax: 415-461-4971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG18512
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT S. FERRETTI
Title or Position: PRESIDENT
Credential: M. D.
Phone: 415-292-9528