Healthcare Provider Details

I. General information

NPI: 1497270508
Provider Name (Legal Business Name): ANGELA GRAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988 HOWARD ST
SAN FRANCISCO CA
94103-4183
US

IV. Provider business mailing address

988 HOWARD ST
SAN FRANCISCO CA
94103-4183
US

V. Phone/Fax

Practice location:
  • Phone: 415-975-0908
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: