Healthcare Provider Details

I. General information

NPI: 1912491499
Provider Name (Legal Business Name): MICHAEL PICO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE STE A2300
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

550 1ST AVE
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 866-817-7463
  • Fax:
Mailing address:
  • Phone: 212-263-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA185532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: