Healthcare Provider Details

I. General information

NPI: 1932789708
Provider Name (Legal Business Name): JAI BRENAY MCQUILLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 SILVER AVE
SAN FRANCISCO CA
94112-1510
US

IV. Provider business mailing address

PO BOX 15122
SAN FRANCISCO CA
94115-0122
US

V. Phone/Fax

Practice location:
  • Phone: 415-334-2500
  • Fax:
Mailing address:
  • Phone: 803-206-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number199651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: