Healthcare Provider Details

I. General information

NPI: 1427453323
Provider Name (Legal Business Name): PRIMO HEALTH COACH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 MISSION ST STE 214
SAN FRANCISCO CA
94110-2458
US

IV. Provider business mailing address

PO BOX 401195
SAN FRANCISCO CA
94140-1195
US

V. Phone/Fax

Practice location:
  • Phone: 415-754-3047
  • Fax:
Mailing address:
  • Phone: 415-754-3047
  • Fax: 415-358-5619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DANIEL SANELLI
Title or Position: OWNER/CLINICAL NUTRITIONIST
Credential: M.SC.
Phone: 415-754-3047