Healthcare Provider Details

I. General information

NPI: 1831714450
Provider Name (Legal Business Name): SAMANTHA NICOLE FREDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2198 CAYUGA AVE
SAN FRANCISCO CA
94112-4023
US

IV. Provider business mailing address

470 DUNCAN ST
SAN FRANCISCO CA
94131-1925
US

V. Phone/Fax

Practice location:
  • Phone: 415-859-5299
  • Fax: 408-510-3484
Mailing address:
  • Phone: 425-443-8658
  • 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: