Healthcare Provider Details

I. General information

NPI: 1699220871
Provider Name (Legal Business Name): ROBERT VERNON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 ALLSTON WAY
SAN FRANCISCO CA
94127-1101
US

IV. Provider business mailing address

45 ALLSTON WAY
SAN FRANCISCO CA
94127-1101
US

V. Phone/Fax

Practice location:
  • Phone: 415-866-5231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: