Healthcare Provider Details

I. General information

NPI: 1497303671
Provider Name (Legal Business Name): NVP MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 24TH STREET
SAN FRANCISCO CA
94114-3904
US

IV. Provider business mailing address

3700 24TH STREET
SAN FRANCISCO CA
94114-3904
US

V. Phone/Fax

Practice location:
  • Phone: 415-641-1019
  • Fax: 415-826-1308
Mailing address:
  • Phone: 415-641-1019
  • Fax: 415-826-1308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH LOUISE RETAILLEAU
Title or Position: CEO
Credential: MD
Phone: 415-641-1019