Healthcare Provider Details

I. General information

NPI: 1861472649
Provider Name (Legal Business Name): JOHN ROBERT NIENOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2186 GEARY BLVD STE 314
SAN FRANCISCO CA
94115-3457
US

IV. Provider business mailing address

2186 GEARY BLVD STE 314
SAN FRANCISCO CA
94115-3457
US

V. Phone/Fax

Practice location:
  • Phone: 415-202-1550
  • Fax: 415-776-8233
Mailing address:
  • Phone: 415-202-1550
  • Fax: 415-776-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number00G795490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: