Healthcare Provider Details

I. General information

NPI: 1013897677
Provider Name (Legal Business Name): FIONA PATRICIA MCCUSKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 STANYAN ST
SAN FRANCISCO CA
94117-1019
US

IV. Provider business mailing address

715 45TH AVE
SAN FRANCISCO CA
94121-3221
US

V. Phone/Fax

Practice location:
  • Phone: 415-668-1000
  • Fax: 415-750-4930
Mailing address:
  • Phone: 415-999-5272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT19948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: