Healthcare Provider Details

I. General information

NPI: 1912449786
Provider Name (Legal Business Name): NATHALIE GORASSINI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 VICENTE ST STE 101
SAN FRANCISCO CA
94116-3082
US

IV. Provider business mailing address

156 2ND AVE
SAN FRANCISCO CA
94118-1415
US

V. Phone/Fax

Practice location:
  • Phone: 415-682-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number11451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: