Healthcare Provider Details

I. General information

NPI: 1356264022
Provider Name (Legal Business Name): NICHOLAS FIORENTINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 17TH ST
SAN FRANCISCO CA
94107-2332
US

IV. Provider business mailing address

1398 5TH AVE
SAN FRANCISCO CA
94122-2619
US

V. Phone/Fax

Practice location:
  • Phone: 415-508-5658
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: