Healthcare Provider Details

I. General information

NPI: 1083713739
Provider Name (Legal Business Name): GERALD RICHARD BUGGS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 GOUGH STREET SUITE 6
SAN FRANCISCO CA
94102
US

IV. Provider business mailing address

3874 SACRAMENTO STREET
SAN FRANCISCO CA
94118
US

V. Phone/Fax

Practice location:
  • Phone: 414-252-5800
  • Fax:
Mailing address:
  • Phone: 415-752-6924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY15494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: