Healthcare Provider Details

I. General information

NPI: 1881094217
Provider Name (Legal Business Name): ISRAEL DE JESUS DIOSDADO HEALTH WORKER II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 MISSION ST
SAN FRANCISCO CA
94110-3104
US

IV. Provider business mailing address

2712 MISSION ST
SAN FRANCISCO CA
94110-3104
US

V. Phone/Fax

Practice location:
  • Phone: 415-401-2700
  • Fax: 415-401-2741
Mailing address:
  • Phone: 415-401-2700
  • Fax: 415-401-2741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT 00019019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: