Healthcare Provider Details

I. General information

NPI: 1184200198
Provider Name (Legal Business Name): JUDITH SHANIKA PELPOLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 4TH ST
SAN FRANCISCO CA
94143-2351
US

IV. Provider business mailing address

801 ALBANY ST DEPT OF
BOSTON MA
02119-2560
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-4079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA195130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: