Healthcare Provider Details

I. General information

NPI: 1437658945
Provider Name (Legal Business Name): NINA FREITAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OWENS ST STE 400
SAN FRANCISCO CA
94158-2335
US

IV. Provider business mailing address

1060 LONGRIDGE RD
OAKLAND CA
94610-2442
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7598
  • Fax:
Mailing address:
  • Phone: 510-520-2621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number294319
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number294319
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number294319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: