Healthcare Provider Details

I. General information

NPI: 1811120157
Provider Name (Legal Business Name): NADA IDRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 MISSION ST
SAN FRANCISCO CA
94103-2911
US

IV. Provider business mailing address

982 MISSION ST
SAN FRANCISCO CA
94103-2911
US

V. Phone/Fax

Practice location:
  • Phone: 415-597-8049
  • Fax:
Mailing address:
  • Phone: 415-597-8049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number66978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: