Healthcare Provider Details

I. General information

NPI: 1023522257
Provider Name (Legal Business Name): JEREMIAH RAE ASUQUE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 STEVENSON ST
SAN FRANCISCO CA
94103-1606
US

IV. Provider business mailing address

555 STEVENSON ST
SAN FRANCISCO CA
94103-1606
US

V. Phone/Fax

Practice location:
  • Phone: 628-217-5800
  • Fax:
Mailing address:
  • Phone: 650-630-9905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: