Healthcare Provider Details

I. General information

NPI: 1013304708
Provider Name (Legal Business Name): JOHN BANCALARI RASI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 KIRKWOOD AVE
SAN FRANCISCO CA
94124-2137
US

IV. Provider business mailing address

1638 KIRKWOOD AVE
SAN FRANCISCO CA
94124-2137
US

V. Phone/Fax

Practice location:
  • Phone: 415-822-5977
  • Fax: 415-671-1042
Mailing address:
  • Phone: 415-822-5977
  • Fax: 415-671-1042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRI-B111015030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: