Healthcare Provider Details

I. General information

NPI: 1225109937
Provider Name (Legal Business Name): ST. LUKE'S SUTTER EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 CESAR CHAVEZ
SAN FRANCISCO CA
94110-4403
US

IV. Provider business mailing address

PO BOX 42557
PHILADELPHIA PA
19101-2557
US

V. Phone/Fax

Practice location:
  • Phone: 415-641-6625
  • Fax:
Mailing address:
  • Phone: 805-563-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGEL L ISCOVICH
Title or Position: GENERAL PARTNER
Credential: MD
Phone: 805-563-3011