Healthcare Provider Details

I. General information

NPI: 1033616941
Provider Name (Legal Business Name): MARC BOZYCH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2018
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PARNASSUS AVE FL 4
SAN FRANCISCO CA
94143-2206
US

IV. Provider business mailing address

521 PARNASSUS AVE FL 4
SAN FRANCISCO CA
94143-2206
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-9035
  • Fax: 415-353-9163
Mailing address:
  • Phone: 415-476-9035
  • Fax: 415-353-9163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34.016010
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A17673
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number34.016010
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number34.016010
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number20A17673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: