Healthcare Provider Details

I. General information

NPI: 1922842400
Provider Name (Legal Business Name): TATIANA NIYIRET BAQUERO DEVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE BLDG 5
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

1280 MINNESOTA ST APT 303
SAN FRANCISCO CA
94107-7444
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-4444
  • Fax:
Mailing address:
  • Phone: 310-384-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW131220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: