Healthcare Provider Details

I. General information

NPI: 1619261138
Provider Name (Legal Business Name): NICOLE CALIO GLYNN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DANIEL BURNHAM CT STE 370C
SAN FRANCISCO CA
94109-0470
US

IV. Provider business mailing address

PO BOX 32071
BELFAST ME
04915-0197
US

V. Phone/Fax

Practice location:
  • Phone: 415-991-4690
  • Fax: 415-732-7030
Mailing address:
  • Phone: 415-991-4690
  • Fax: 415-732-7030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA116076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: