Healthcare Provider Details

I. General information

NPI: 1366766453
Provider Name (Legal Business Name): COURTNEY LENNON GIRAUDO CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 VAN NESS AVENUE 3RD FLR, CALIFORNIA PACIFIC MEDICAL CTR
SAN FRANCISCO CA
94120
US

IV. Provider business mailing address

1625 VAN NESS AVENUE 3RD FLR, CALIFORNIA PACIFIC MEDICAL CTR
SAN FRANCISCO CA
94120
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-0830
  • Fax: 415-731-2314
Mailing address:
  • Phone: 415-600-0830
  • Fax: 415-731-2314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN570791
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP15098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: