Healthcare Provider Details

I. General information

NPI: 1003091596
Provider Name (Legal Business Name): SAN FRANCISCO PAIN MANAGEMENT AND PHYSICAL THERAPY - MISSION APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 MISSION ST SUITE #331
SAN FRANCISCO CA
94110-2468
US

IV. Provider business mailing address

2480 MISSION ST SUITE #331
SAN FRANCISCO CA
94110-2468
US

V. Phone/Fax

Practice location:
  • Phone: 415-282-6491
  • Fax:
Mailing address:
  • Phone: 415-282-6491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA66560
License Number StateCA

VIII. Authorized Official

Name: DR. PARVEZ M. FATTEH
Title or Position: OWNER/CEO
Credential: MD
Phone: 415-282-6490