Healthcare Provider Details

I. General information

NPI: 1255961355
Provider Name (Legal Business Name): CRICKET HEALTH MEDICAL PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 MARKET STREET STE 39516
SAN FRANCISCO CA
94104-4534
US

IV. Provider business mailing address

548 MARKET STREET PMB 39516
SAN FRANCISCO CA
94104-4534
US

V. Phone/Fax

Practice location:
  • Phone: 833-644-8244
  • Fax:
Mailing address:
  • Phone: 833-644-8244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JULIE DOMINGUEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 833-644-8244