Healthcare Provider Details

I. General information

NPI: 1255486395
Provider Name (Legal Business Name): MIRIAM SHIPP M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CONNECTICUT ST
SAN FRANCISCO CA
94107
US

IV. Provider business mailing address

1348 HOPKINS ST
BERKELEY CA
94702-1147
US

V. Phone/Fax

Practice location:
  • Phone: 415-621-5055
  • Fax: 415-621-0611
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberG48513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: