Healthcare Provider Details

I. General information

NPI: 1215083035
Provider Name (Legal Business Name): RICHARD R. TAVERNETTI, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WEBSTER ST SUITE 115
SAN FRANCISCO CA
94115-2373
US

IV. Provider business mailing address

2100 WEBSTER ST SUITE 115
SAN FRANCISCO CA
94115-2373
US

V. Phone/Fax

Practice location:
  • Phone: 415-923-3033
  • Fax: 415-923-3083
Mailing address:
  • Phone: 415-923-3033
  • Fax: 415-923-3083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberA23135
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD ROLAND TAVERNETTI
Title or Position: OWNER
Credential: M.D.
Phone: 415-923-3033