Healthcare Provider Details

I. General information

NPI: 1235590761
Provider Name (Legal Business Name): IDEAL HEALTHCARE NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 SEBASTIAN DR
MILLBRAE CA
94030-2940
US

IV. Provider business mailing address

209 SEBASTIAN DR
MILLBRAE CA
94030-2940
US

V. Phone/Fax

Practice location:
  • Phone: 415-606-5213
  • Fax:
Mailing address:
  • Phone: 415-606-5213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14707
License Number StateCA

VIII. Authorized Official

Name: MS. RACHEL JAYNE HO
Title or Position: PRESIDENT
Credential: FNP
Phone: 415-606-5213