Healthcare Provider Details

I. General information

NPI: 1033508783
Provider Name (Legal Business Name): HEALTHRIGHT360
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 MISSION ST
SAN FRANCISCO CA
94103-2417
US

IV. Provider business mailing address

1818 GILBRETH RD
BURLINGAME CA
94010-1225
US

V. Phone/Fax

Practice location:
  • Phone: 415-762-1498
  • Fax: 415-970-7561
Mailing address:
  • Phone: 650-348-6603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC0506301713
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberC0506301713
License Number StateCA

VIII. Authorized Official

Name: MR. WAYNE GARCIA
Title or Position: VICE PRESIDENT
Credential:
Phone: 415-762-1498