Healthcare Provider Details

I. General information

NPI: 1659074847
Provider Name (Legal Business Name): MS. NAOMI PROCHOVNICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 5TH AVE
SAN RAFAEL CA
94901-3202
US

IV. Provider business mailing address

98 PARKRIDGE DR APT 305
SAN FRANCISCO CA
94131-3430
US

V. Phone/Fax

Practice location:
  • Phone: 415-991-3765
  • Fax:
Mailing address:
  • Phone: 414-152-7957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: