Healthcare Provider Details

I. General information

NPI: 1407352750
Provider Name (Legal Business Name): MR. PETER DALE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 MARKET ST
SAN FRANCISCO CA
94102-4801
US

IV. Provider business mailing address

1282 MARKET ST
SAN FRANCISCO CA
94102-4801
US

V. Phone/Fax

Practice location:
  • Phone: 415-579-3021
  • Fax: 415-941-7313
Mailing address:
  • Phone: 415-579-3021
  • Fax: 415-941-7313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: