Healthcare Provider Details

I. General information

NPI: 1558013441
Provider Name (Legal Business Name): MAIA GRACE ASIANO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 MISSION ST
SAN FRANCISCO CA
94103-2705
US

IV. Provider business mailing address

1263 MISSION ST
SAN FRANCISCO CA
94103-2705
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-3000
  • Fax: 415-514-6466
Mailing address:
  • Phone: 415-502-6000
  • Fax: 415-514-6466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number95266746
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number95266746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: