Healthcare Provider Details

I. General information

NPI: 1992743579
Provider Name (Legal Business Name): MOLLY DETGEN MAGNANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WEBSTER ST STE 112
SAN FRANCISCO CA
94115-2374
US

IV. Provider business mailing address

2100 WEBSTER ST STE 112
SAN FRANCISCO CA
94115-2374
US

V. Phone/Fax

Practice location:
  • Phone: 415-923-3060
  • Fax: 415-749-0841
Mailing address:
  • Phone: 415-923-3060
  • Fax: 415-749-0841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA80346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: