Healthcare Provider Details

I. General information

NPI: 1912205766
Provider Name (Legal Business Name): MATS F. HAGSTROM, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 HYDE ST STE 423
SAN FRANCISCO CA
94109-4845
US

IV. Provider business mailing address

909 HYDE ST STE 423
SAN FRANCISCO CA
94109-4845
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-4343
  • Fax: 415-885-4267
Mailing address:
  • Phone: 415-885-4343
  • Fax: 415-885-4267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG80721
License Number StateCA

VIII. Authorized Official

Name: DR. MATS F. HAGSTROM
Title or Position: OWNER
Credential: M.D.
Phone: 415-885-4343