Healthcare Provider Details

I. General information

NPI: 1255468864
Provider Name (Legal Business Name): HADEN PATRICK NICHOLL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 POTRERO AVE L UNIT
SAN FRANCISCO CA
94110-2869
US

IV. Provider business mailing address

50 LAFAYETTE ST
SAN FRANCISCO CA
94103-2536
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-6300
  • Fax:
Mailing address:
  • Phone:
  • 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: