Healthcare Provider Details

I. General information

NPI: 1710019740
Provider Name (Legal Business Name): MARK H. FREEMAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LECH WALESA TOM WADDELL CLINIC
SAN FRANCISCO CA
94102-4506
US

IV. Provider business mailing address

50 LECH WALESA TOM WADDELL CLINIC
SAN FRANCISCO CA
94102-4506
US

V. Phone/Fax

Practice location:
  • Phone: 415-355-7490
  • Fax: 415-355-7407
Mailing address:
  • Phone: 415-355-7490
  • Fax: 415-355-7407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN397538
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNPF3259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: