Healthcare Provider Details

I. General information

NPI: 1346843158
Provider Name (Legal Business Name): SILVIO SIMUNOVIC RDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 20TH AVE APT 4
SAN FRANCISCO CA
94122-3448
US

IV. Provider business mailing address

1471 20TH AVE APT 4
SAN FRANCISCO CA
94122-3448
US

V. Phone/Fax

Practice location:
  • Phone: 415-825-2329
  • Fax:
Mailing address:
  • Phone: 415-825-2329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberK7L7R5Z9
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number90325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: