Healthcare Provider Details

I. General information

NPI: 1578076675
Provider Name (Legal Business Name): CAROLINE BITTNER PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2017
Last Update Date: 06/30/2022
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HAYES ST STE 208
SAN FRANCISCO CA
94117-1078
US

IV. Provider business mailing address

2250 HAYES ST STE 208
SAN FRANCISCO CA
94117-1078
US

V. Phone/Fax

Practice location:
  • Phone: 415-259-4104
  • Fax: 408-294-6595
Mailing address:
  • Phone: 415-259-4101
  • Fax: 408-294-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number3466
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number55478
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number55478
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA55478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: