Healthcare Provider Details

I. General information

NPI: 1568519981
Provider Name (Legal Business Name): IRIS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 VALENCIA ST SUITE 222
SAN FRANCISCO CA
94103-3547
US

IV. Provider business mailing address

333 VALENCIA ST SUITE 222
SAN FRANCISCO CA
94103-3547
US

V. Phone/Fax

Practice location:
  • Phone: 415-864-2364
  • Fax: 415-864-0116
Mailing address:
  • Phone: 415-864-2364
  • Fax: 415-864-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. PAMELA FAIRLEY
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 415-864-2364