Healthcare Provider Details

I. General information

NPI: 1639733231
Provider Name (Legal Business Name): KATHERINE CECIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 09/19/2022
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE RM S257A
SAN FRANCISCO CA
94143-2205
US

IV. Provider business mailing address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-8358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA181796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: