Healthcare Provider Details

I. General information

NPI: 1891318374
Provider Name (Legal Business Name): KATERYNA YERMOLAIEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 3RD ST
SAN FRANCISCO CA
94124-3101
US

IV. Provider business mailing address

150 EXECUTIVE PARK BLVD
SAN FRANCISCO CA
94134-3303
US

V. Phone/Fax

Practice location:
  • Phone: 415-822-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: