Healthcare Provider Details

I. General information

NPI: 1093856478
Provider Name (Legal Business Name): STEVEN JOSEPH BOSQUE R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 VICENTE ST
SAN FRANCISCO CA
94116-2923
US

IV. Provider business mailing address

261 RANDALL ST
SAN FRANCISCO CA
94131-2738
US

V. Phone/Fax

Practice location:
  • Phone: 415-682-3132
  • Fax:
Mailing address:
  • Phone: 415-647-8245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number558139
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: