Healthcare Provider Details

I. General information

NPI: 1053239004
Provider Name (Legal Business Name): DR. CARLSON MATHIAS NGWABIFU ASANGHANWA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PARNASSUS AVE
SAN FRANCISCO CA
94143-2206
US

IV. Provider business mailing address

521 PARNASSUS AVE
SAN FRANCISCO CA
94143-2206
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-1043
  • Fax:
Mailing address:
  • Phone: 650-676-9716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberSPI971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: