Healthcare Provider Details

I. General information

NPI: 1780841650
Provider Name (Legal Business Name): MELISSA ANN TANNENBAUM M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 15TH ST
SAN FRANCISCO CA
94114-1238
US

IV. Provider business mailing address

2220 15TH ST
SAN FRANCISCO CA
94114-1238
US

V. Phone/Fax

Practice location:
  • Phone: 415-621-1185
  • Fax: 415-621-0810
Mailing address:
  • Phone: 415-621-1185
  • Fax: 415-621-0810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU1007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: