Healthcare Provider Details

I. General information

NPI: 1609308642
Provider Name (Legal Business Name): STEPHANY C RUSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 7TH ST
SAN FRANCISCO CA
94103-4003
US

IV. Provider business mailing address

229 7TH ST
SAN FRANCISCO CA
94103-4003
US

V. Phone/Fax

Practice location:
  • Phone: 415-503-6000
  • Fax: 415-503-6096
Mailing address:
  • Phone: 415-503-6000
  • Fax: 415-503-6096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA159498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: