Healthcare Provider Details

I. General information

NPI: 1881711257
Provider Name (Legal Business Name): SUSAN T. OBATA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 COLE ST COMMUNITY HEALTH PROGRAMS FOR YOUTH-COLE ST CLINIC
SAN FRANCISCO CA
94117-2800
US

IV. Provider business mailing address

555 COLE ST COMMUNITY HEALTH PROGRAMS FOR YOUTH-COLE ST CLINIC
SAN FRANCISCO CA
94117-2800
US

V. Phone/Fax

Practice location:
  • Phone: 415-751-8181
  • Fax: 415-386-8212
Mailing address:
  • Phone: 415-751-8181
  • Fax: 415-386-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG67882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: