Healthcare Provider Details

I. General information

NPI: 1386844017
Provider Name (Legal Business Name): PREFERRED HEALTHCARE REGISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4655 RUFFNER ST SUITE 270
SAN DIEGO CA
92111-2275
US

IV. Provider business mailing address

1738 SPRUCE ST APT. C
BERKELEY CA
94709-1758
US

V. Phone/Fax

Practice location:
  • Phone: 800-787-6787
  • Fax:
Mailing address:
  • Phone: 415-823-4641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number1891
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number1891
License Number StateCA

VIII. Authorized Official

Name: KAY LYNN SCHREVE
Title or Position: PHYSICAL THERAPIST ASSISTANT
Credential: P.T.A.
Phone: 415-823-4641