Healthcare Provider Details

I. General information

NPI: 1891285995
Provider Name (Legal Business Name): HALEY MARLENE BOGDANOVICH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HALEY MARLENE BOGERS PA-C

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 EMBARCADERO CTR
SAN FRANCISCO CA
94111-3823
US

IV. Provider business mailing address

1 EMBARCADERO CTR STE 1900
SAN FRANCISCO CA
94111-3723
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number55920
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: