Healthcare Provider Details

I. General information

NPI: 1750950705
Provider Name (Legal Business Name): INTELLIHEALTH MSO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 GRAHAM ST STE 124
SAN FRANCISCO CA
94129-1724
US

IV. Provider business mailing address

37 GRAHAM ST STE 124
SAN FRANCISCO CA
94129-1724
US

V. Phone/Fax

Practice location:
  • Phone: 646-397-0208
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID BASS
Title or Position: COO
Credential:
Phone: 415-710-7775