Healthcare Provider Details

I. General information

NPI: 1972259281
Provider Name (Legal Business Name): MARY LIGAYA B SACE LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CLEMENT ST
SAN FRANCISCO CA
94121-1563
US

IV. Provider business mailing address

187 COUNTRY CLUB DR APT 11
SOUTH SAN FRANCISCO CA
94080-4344
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4810
  • Fax:
Mailing address:
  • Phone: 805-824-1627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number723560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: