Healthcare Provider Details

I. General information

NPI: 1831573633
Provider Name (Legal Business Name): KRISZTINA EMODI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST GATEWAY MEDICAL BUILDING
SAN FRANCISCO CA
94158-2350
US

IV. Provider business mailing address

875 VERMONT ST APT 203
SAN FRANCISCO CA
94107-2650
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-8635
  • Fax:
Mailing address:
  • Phone: 415-630-0309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP23637
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number731816
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number23637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: