Healthcare Provider Details

I. General information

NPI: 1114944972
Provider Name (Legal Business Name): MAURIZIO BONACINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 VALENCIA ST STE 208
SAN FRANCISCO CA
94110-4420
US

IV. Provider business mailing address

2307 17TH AVE
SAN FRANCISCO CA
94116-2507
US

V. Phone/Fax

Practice location:
  • Phone: 415-641-3430
  • Fax:
Mailing address:
  • Phone: 415-722-7215
  • Fax: 415-600-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberA43170
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA43170
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: