Healthcare Provider Details

I. General information

NPI: 1053438424
Provider Name (Legal Business Name): MARY A. ANGEL NP MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 POTRERO AVE MENTAL HEALTH REHABILITATION FACILITY
SAN FRANCISCO CA
94110-2869
US

IV. Provider business mailing address

887 POTRERO AVE MENTAL HEALTH REHABILITATION FACILITY
SAN FRANCISCO CA
94110-2869
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-6301
  • Fax: 415-206-6918
Mailing address:
  • Phone: 415-206-6301
  • Fax: 415-206-6918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN352691
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPF6613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: