Healthcare Provider Details

I. General information

NPI: 1801355482
Provider Name (Legal Business Name): BRIGHTSIDE MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 11/18/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5214F DIAMOND HEIGHTS BLVD # 345
SAN FRANCISCO CA
94131-2175
US

IV. Provider business mailing address

2261 MARKET ST STE 10222
SAN FRANCISCO CA
94114-1612
US

V. Phone/Fax

Practice location:
  • Phone: 415-360-3348
  • Fax: 855-350-5708
Mailing address:
  • Phone: 415-360-3348
  • Fax: 855-350-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MIRENE WINSBERG
Title or Position: ADMINISTRATION
Credential:
Phone: 415-360-3348