Healthcare Provider Details

I. General information

NPI: 1477485092
Provider Name (Legal Business Name): MARIE GERONIMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 11TH ST
SAN FRANCISCO CA
94103-3732
US

IV. Provider business mailing address

245 11TH ST
SAN FRANCISCO CA
94103-3732
US

V. Phone/Fax

Practice location:
  • Phone: 415-355-0311
  • Fax: 415-355-0353
Mailing address:
  • Phone: 415-355-0311
  • Fax: 415-355-0353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: