Healthcare Provider Details

I. General information

NPI: 1780716894
Provider Name (Legal Business Name): DANIEL MABALATAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 HAYES ST 1735 MISSION STREET, S.F. CA 94103
SAN FRANCISCO CA
94117-1128
US

IV. Provider business mailing address

2024 HAYES ST
SAN FRANCISCO CA
94117-1128
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-5111
  • Fax:
Mailing address:
  • Phone: 415-750-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: