Healthcare Provider Details

I. General information

NPI: 1659699106
Provider Name (Legal Business Name): DIANE BARBARA VACCARO RN, MS, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 LAGUNA HONDA BLVD
SAN FRANCISCO CA
94116-1411
US

IV. Provider business mailing address

375 LAGUNA HONDA BLVD
SAN FRANCISCO CA
94116-1411
US

V. Phone/Fax

Practice location:
  • Phone: 415-759-4690
  • Fax:
Mailing address:
  • Phone: 415-759-4690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberRN 331495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: