Healthcare Provider Details

I. General information

NPI: 1609154038
Provider Name (Legal Business Name): NOE VALLEY PEDIATRICS, A MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 24TH ST
SAN FRANCISCO CA
94114-3904
US

IV. Provider business mailing address

3700 24TH ST
SAN FRANCISCO CA
94114-3904
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG28253
License Number StateCA

VIII. Authorized Official

Name: DR. JAMES E SCHWANKE
Title or Position: PRESIDENT
Credential: MD
Phone: 415-641-1019