Healthcare Provider Details

I. General information

NPI: 1093225138
Provider Name (Legal Business Name): VIRTA MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MONTGOMERY ST STE 810
SAN FRANCISCO CA
94111-2677
US

IV. Provider business mailing address

655 MONTGOMERY ST STE 810
SAN FRANCISCO CA
94111-2677
US

V. Phone/Fax

Practice location:
  • Phone: 844-847-8216
  • Fax: 415-520-9150
Mailing address:
  • Phone: 844-847-8216
  • Fax: 415-520-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY PETERSON STANLEY
Title or Position: PRESIDENT
Credential: MD
Phone: 844-847-8216