Healthcare Provider Details

I. General information

NPI: 1790520369
Provider Name (Legal Business Name): GINA CLAUNA QUIDILIG SUD APPRENTICES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 BUENA VISTA AVE W
SAN FRANCISCO CA
94117-4108
US

IV. Provider business mailing address

1177 MARKET ST APT 1144
SAN FRANCISCO CA
94103-1823
US

V. Phone/Fax

Practice location:
  • Phone: 415-554-1450
  • Fax: 415-554-1475
Mailing address:
  • Phone: 415-678-7201
  • Fax:

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:
Title or Position:
Credential:
Phone: