Healthcare Provider Details

I. General information

NPI: 1366590838
Provider Name (Legal Business Name): STUART M PICKEL MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 HYDE STREET SUITE 425
SAN FRANCISCO CA
94109-4846
US

IV. Provider business mailing address

909 HYDE STREET SUITE 425
SAN FRANCISCO CA
94109-4846
US

V. Phone/Fax

Practice location:
  • Phone: 415-928-3277
  • Fax: 415-928-0408
Mailing address:
  • Phone: 415-928-3277
  • Fax: 415-928-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberC32405
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC32405
License Number StateCA

VIII. Authorized Official

Name: STUART MICHAEL PICKEL
Title or Position: PRESIDENT
Credential: MD
Phone: 415-928-3277