Healthcare Provider Details

I. General information

NPI: 1669180477
Provider Name (Legal Business Name): JENNA MARIE CULLINAN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 SUTTER STREET STE 1400
SAN FRANCISCO CA
94108
US

IV. Provider business mailing address

2639 15TH AVE
SAN FRANCISCO CA
94127-1313
US

V. Phone/Fax

Practice location:
  • Phone: 415-362-2901
  • Fax:
Mailing address:
  • Phone: 415-994-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3765
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: