Healthcare Provider Details

I. General information

NPI: 1831601145
Provider Name (Legal Business Name): CHANEL ELISE RODRIGUEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHANEL ELISE GARCIA NP

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SUTTER ST STE 600
SAN FRANCISCO CA
94104-4020
US

IV. Provider business mailing address

130 SUTTER ST FL 2
SAN FRANCISCO CA
94104-4009
US

V. Phone/Fax

Practice location:
  • Phone: 415-291-0480
  • Fax: 415-252-7176
Mailing address:
  • Phone: 415-347-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95053133
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95006138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: