Healthcare Provider Details

I. General information

NPI: 1912106592
Provider Name (Legal Business Name): MS. CHARISSE LA SHAUNE LLOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1663 MISSION ST STE 604
SAN FRANCISCO CA
94103-2473
US

IV. Provider business mailing address

1010 GOUGH ST
SAN FRANCISCO CA
94109-7622
US

V. Phone/Fax

Practice location:
  • Phone: 415-474-7310
  • Fax: 415-673-2488
Mailing address:
  • Phone: 415-474-7310
  • Fax: 415-673-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: