Healthcare Provider Details

I. General information

NPI: 1912649294
Provider Name (Legal Business Name): CHRISTINE CONNELL STUDENMUND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 16TH ST FL 4
SAN FRANCISCO CA
94143-2549
US

IV. Provider business mailing address

550 16TH ST FL 4
SAN FRANCISCO CA
94143-2549
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-2362
  • Fax: 415-476-5354
Mailing address:
  • Phone: 415-502-2362
  • Fax: 415-476-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10715
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA189510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: