Healthcare Provider Details

I. General information

NPI: 1760474894
Provider Name (Legal Business Name): LUCIA R TUFFANELLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER ST STE 1306
SAN FRANCISCO CA
94108-4206
US

IV. Provider business mailing address

450 SUTTER ST STE 1306
SAN FRANCISCO CA
94108-4206
US

V. Phone/Fax

Practice location:
  • Phone: 415-781-4083
  • Fax: 415-781-4104
Mailing address:
  • Phone: 415-781-4083
  • Fax: 415-781-4104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG53460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: