Healthcare Provider Details

I. General information

NPI: 1578482139
Provider Name (Legal Business Name): PAIGE DYJACK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 CALIFORNIA ST
SAN FRANCISCO CA
94118-1725
US

IV. Provider business mailing address

590 ALBION AVE
WOODSIDE CA
94062-3665
US

V. Phone/Fax

Practice location:
  • Phone: 650-436-2225
  • Fax:
Mailing address:
  • Phone: 909-991-5626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95149563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: