Healthcare Provider Details

I. General information

NPI: 1285643528
Provider Name (Legal Business Name): CHRYSALIS MEDICAL TECHNOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 SIR FRANCIS DRAKE BLVD STE 101C
KENTFIELD CA
94904-1548
US

IV. Provider business mailing address

929 SIR FRANCIS DRAKE BLVD STE 101C
KENTFIELD CA
94904-1548
US

V. Phone/Fax

Practice location:
  • Phone: 415-457-7400
  • Fax: 415-454-3200
Mailing address:
  • Phone: 415-457-7400
  • Fax: 415-454-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSIE J DAMEYER
Title or Position: VICE PRESIDENT
Credential: PHD
Phone: 415-457-7400