Healthcare Provider Details

I. General information

NPI: 1003219288
Provider Name (Legal Business Name): MR. ROMAN KING FLINTROY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 12/16/2025
Certification Date:
Deactivation Date: 10/02/2025
Reactivation Date: 12/16/2025

III. Provider practice location address

982 MISSION ST
SAN FRANCISCO CA
94103-2911
US

IV. Provider business mailing address

982 MISSION ST
SAN FRANCISCO CA
94103-2911
US

V. Phone/Fax

Practice location:
  • Phone: 415-597-8046
  • Fax:
Mailing address:
  • Phone: 510-375-5948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: