Healthcare Provider Details

I. General information

NPI: 1508226200
Provider Name (Legal Business Name): PRIVATE MEDICAL PHYSICIANS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 CALIFORNIA ST STE 202
SAN FRANCISCO CA
94118-1717
US

IV. Provider business mailing address

3580 CALIFORNIA ST STE 202
SAN FRANCISCO CA
94118-1717
US

V. Phone/Fax

Practice location:
  • Phone: 415-830-3090
  • Fax:
Mailing address:
  • Phone: 415-830-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA061482
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA73730
License Number StateCA

VIII. Authorized Official

Name: MIKE SARMIENTO
Title or Position: COO
Credential:
Phone: 415-830-3090