Healthcare Provider Details

I. General information

NPI: 1518997311
Provider Name (Legal Business Name): SAN FRANCISCO SURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 CALIFORNIA ST SUITE 616
SAN FRANCISCO CA
94118-1522
US

IV. Provider business mailing address

3838 CALIFORNIA ST SUITE 616
SAN FRANCISCO CA
94118-1522
US

V. Phone/Fax

Practice location:
  • Phone: 415-668-0411
  • Fax: 415-668-6352
Mailing address:
  • Phone: 415-668-0411
  • Fax: 415-668-6352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberC25582
License Number StateCA

VIII. Authorized Official

Name: ANNE ODONOGHUE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 415-668-0411