Healthcare Provider Details

I. General information

NPI: 1790645786
Provider Name (Legal Business Name): RENA GADIMOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 MISSION ST
SAN FRANCISCO CA
94103-2705
US

IV. Provider business mailing address

1263 MISSION ST
SAN FRANCISCO CA
94103-2705
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-3000
  • Fax:
Mailing address:
  • Phone: 628-222-9753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: