Healthcare Provider Details

I. General information

NPI: 1992245427
Provider Name (Legal Business Name): JENNIFER MCEVOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 1ST ST UNIT S805
SAN FRANCISCO CA
94105-3067
US

IV. Provider business mailing address

5758 GEARY BLVD # 214
SAN FRANCISCO CA
94121-2112
US

V. Phone/Fax

Practice location:
  • Phone: 415-566-4666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: