Healthcare Provider Details

I. General information

NPI: 1598519910
Provider Name (Legal Business Name): PROJECT INDIGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2299 POST ST STE 103
SAN FRANCISCO CA
94115-3443
US

IV. Provider business mailing address

338 MAIN ST UNIT 8D
SAN FRANCISCO CA
94105-2186
US

V. Phone/Fax

Practice location:
  • Phone: 415-923-1036
  • Fax:
Mailing address:
  • Phone: 415-825-2815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA GORDON
Title or Position: MEDICAL OFFICER
Credential:
Phone: 416-370-2077