Healthcare Provider Details

I. General information

NPI: 1487895041
Provider Name (Legal Business Name): BRUNNO RISTOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WEBSTER ST STE 501
SAN FRANCISCO CA
94115-2381
US

IV. Provider business mailing address

2100 WEBSTER ST STE 501
SAN FRANCISCO CA
94115-2381
US

V. Phone/Fax

Practice location:
  • Phone: 415-202-1507
  • Fax: 415-202-0131
Mailing address:
  • Phone: 415-202-1507
  • Fax: 415-202-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA25199
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: