Healthcare Provider Details

I. General information

NPI: 1467044339
Provider Name (Legal Business Name): JACQUELYN VERZE-REEHER CPT -00040713
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 GOUGH ST
SAN FRANCISCO CA
94103-5419
US

IV. Provider business mailing address

PO BOX 156675
SAN FRANCISCO CA
94115-6675
US

V. Phone/Fax

Practice location:
  • Phone: 415-374-4013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT-00040713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: