Healthcare Provider Details

I. General information

NPI: 1255666152
Provider Name (Legal Business Name): MRS. CAROLIN HAGENSTROEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 SANTA MARINA ST
SAN FRANCISCO CA
94110-5431
US

IV. Provider business mailing address

39 SANTA MARINA STREET
SAN FRANCISCO CA
94110-0039
US

V. Phone/Fax

Practice location:
  • Phone: 415-282-8183
  • Fax:
Mailing address:
  • Phone: 415-282-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0000007715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: