Healthcare Provider Details

I. General information

NPI: 1073046934
Provider Name (Legal Business Name): POOJA JAEEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 CESAR CHAVEZ
SAN FRANCISCO CA
94110-4403
US

IV. Provider business mailing address

601 VAN NESS AVE STE E3619
SAN FRANCISCO CA
94102-3200
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-6000
  • Fax:
Mailing address:
  • Phone: 415-531-9047
  • Fax: 415-213-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA158017
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA158017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: