Healthcare Provider Details

I. General information

NPI: 1720222169
Provider Name (Legal Business Name): RENATA G KIEFER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 LOCKSLEY AVE APT 10A
SAN FRANCISCO CA
94122-3878
US

IV. Provider business mailing address

6 LOCKSLEY AVE #10A
SAN FRANCISCO CA
94122-3854
US

V. Phone/Fax

Practice location:
  • Phone: 415-731-3672
  • Fax:
Mailing address:
  • Phone: 415-731-3672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number53596
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: