Healthcare Provider Details

I. General information

NPI: 1134748361
Provider Name (Legal Business Name): ASHLEY SHATOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 KEITH ST, SAN FRANCISCO, CA 94124
SAN FRANCISCO CA
94124
US

IV. Provider business mailing address

2401 KEITH ST, SAN FRANCISCO, CA 94124
SAN FRANCISCO CA
94124
US

V. Phone/Fax

Practice location:
  • Phone: 628-754-8100
  • Fax:
Mailing address:
  • Phone: 628-754-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number3910
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA178386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: