Healthcare Provider Details

I. General information

NPI: 1831710128
Provider Name (Legal Business Name): JESSICA PRICE MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 18TH ST
SAN FRANCISCO CA
94143-4200
US

IV. Provider business mailing address

45 STUART ST APT 2708
BOSTON MA
02116-4794
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2002
  • Fax:
Mailing address:
  • Phone: 615-598-1390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number284993
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA203827
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: