Healthcare Provider Details

I. General information

NPI: 1528363249
Provider Name (Legal Business Name): TRES PEROS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 FRONT ST FL 6
SAN FRANCISCO CA
94111-4422
US

IV. Provider business mailing address

222 FRONT ST FL 6
SAN FRANCISCO CA
94111-4422
US

V. Phone/Fax

Practice location:
  • Phone: 415-956-2884
  • Fax: 844-877-1864
Mailing address:
  • Phone: 415-956-2884
  • Fax: 844-877-1864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberE3725
License Number StateCA

VIII. Authorized Official

Name: DR. JENNIFER L SANDERS
Title or Position: PRESIDENT
Credential: DPM
Phone: 415-956-2884