Healthcare Provider Details

I. General information

NPI: 1225792898
Provider Name (Legal Business Name): MEDVIDI HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1884 MARKET ST
SAN FRANCISCO CA
94102-6227
US

IV. Provider business mailing address

1884 MARKET ST
SAN FRANCISCO CA
94102-6227
US

V. Phone/Fax

Practice location:
  • Phone: 415-554-0171
  • Fax: 415-449-3540
Mailing address:
  • Phone: 415-554-0171
  • Fax: 415-449-3540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ED J ORTIZ
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 415-910-9362