Healthcare Provider Details

I. General information

NPI: 1346679578
Provider Name (Legal Business Name): PETER GUMPRECHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 HOWARD ST
SAN FRANCISCO CA
94103-2822
US

IV. Provider business mailing address

1049 HOWARD ST
SAN FRANCISCO CA
94103-2822
US

V. Phone/Fax

Practice location:
  • Phone: 415-241-1175
  • Fax:
Mailing address:
  • Phone: 415-293-2144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: