Healthcare Provider Details

I. General information

NPI: 1497320618
Provider Name (Legal Business Name): THE SAN FRANCISCO VEIN AND VASCULAR INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DANIEL BURNHAM CT STE 205C
SAN FRANCISCO CA
94109-5472
US

IV. Provider business mailing address

1 DANIEL BURNHAM CT STE 205C
SAN FRANCISCO CA
94109-5472
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-7056
  • Fax: 415-221-7058
Mailing address:
  • Phone: 415-221-7056
  • Fax: 415-221-7058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELE M VILLEGAS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 415-230-2422