Healthcare Provider Details

I. General information

NPI: 1861323024
Provider Name (Legal Business Name): LEE STAUB
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 SANTIAGO ST
SAN FRANCISCO CA
94116-1526
US

IV. Provider business mailing address

3045 SANTIAGO ST
SAN FRANCISCO CA
94116-1526
US

V. Phone/Fax

Practice location:
  • Phone: 415-401-2525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225CX0006X
TaxonomyOrientation and Mobility Training Rehabilitation Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: