Healthcare Provider Details

I. General information

NPI: 1164378576
Provider Name (Legal Business Name): BLUE ABA CALIFORNIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 STEVENSON ST STE 400
SAN FRANCISCO CA
94105-0908
US

IV. Provider business mailing address

71 STEVENSON ST STE 400
SAN FRANCISCO CA
94105-0908
US

V. Phone/Fax

Practice location:
  • Phone: 415-228-6879
  • Fax: 623-748-1919
Mailing address:
  • Phone: 415-228-6879
  • Fax: 623-748-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GERSHON FINK
Title or Position: MANAGER
Credential: DO
Phone: 415-228-6879