Healthcare Provider Details

I. General information

NPI: 1346710464
Provider Name (Legal Business Name): ANDRY KOZIOL NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2018
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 MARKET ST
SAN FRANCISCO CA
94102-6228
US

IV. Provider business mailing address

1998 MARKET ST
SAN FRANCISCO CA
94102-6228
US

V. Phone/Fax

Practice location:
  • Phone: 415-792-6040
  • Fax:
Mailing address:
  • Phone: 415-792-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95121768
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: