Healthcare Provider Details

I. General information

NPI: 1952837056
Provider Name (Legal Business Name): JERICK PORNILLOSA SAN MATEO PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CLEMENT ST
SAN FRANCISCO CA
94121-1563
US

IV. Provider business mailing address

4150 CLEMENT ST
SAN FRANCISCO CA
94121-1563
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number75743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: