Healthcare Provider Details

I. General information

NPI: 1609201607
Provider Name (Legal Business Name): JAVONNE N. GWINN ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 GUERRERO ST
SAN FRANCISCO CA
94110-1015
US

IV. Provider business mailing address

450 GUERRERO ST
SAN FRANCISCO CA
94110-1015
US

V. Phone/Fax

Practice location:
  • Phone: 415-503-1735
  • Fax: 415-520-0838
Mailing address:
  • Phone: 415-503-1735
  • Fax: 415-520-0838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW36974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: