Healthcare Provider Details

I. General information

NPI: 1275172769
Provider Name (Legal Business Name): EDWARD JOSEPH FLORES VILLEGAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 TREAT AVE
SAN FRANCISCO CA
94110-5234
US

IV. Provider business mailing address

1045 BRUNSWICK ST
DALY CITY CA
94014-1202
US

V. Phone/Fax

Practice location:
  • Phone: 415-641-8000
  • Fax: 415-641-8002
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246YR1600X
TaxonomyRegistered Record Administrator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: