Healthcare Provider Details

I. General information

NPI: 1194106153
Provider Name (Legal Business Name): SVETLANA KIPNIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LANA KIPNIS

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 4TH ST
SAN RAFAEL CA
94901-3213
US

IV. Provider business mailing address

718 4TH ST
SAN RAFAEL CA
94901-3213
US

V. Phone/Fax

Practice location:
  • Phone: 415-532-1127
  • Fax:
Mailing address:
  • Phone:
  • Fax: 415-455-5386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95030914
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: