Healthcare Provider Details

I. General information

NPI: 1184015950
Provider Name (Legal Business Name): KRYSTLE SHEREE DANRIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 QUESADA AVE
SAN FRANCISCO CA
94124-2334
US

IV. Provider business mailing address

1442 REVERE AVE
SAN FRANCISCO CA
94124-2758
US

V. Phone/Fax

Practice location:
  • Phone: 415-822-5977
  • Fax: 415-671-1042
Mailing address:
  • Phone: 415-822-5977
  • Fax: 415-671-1042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: