Healthcare Provider Details

I. General information

NPI: 1285169714
Provider Name (Legal Business Name): JEANNETTE MATHIEU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVENUE BLDG 5, 1ST FL
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

PO BOX 743749
LOS ANGELES CA
90074-3749
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8020
  • Fax: 628-206-4004
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number13276869-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA160128
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: