Healthcare Provider Details

I. General information

NPI: 1376722405
Provider Name (Legal Business Name): DEPT. OF PUBLIE HEALTH-MCAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PIERCE ST
SAN FRANCISCO CA
94115-4005
US

IV. Provider business mailing address

1301 PIERCE ST
SAN FRANCISCO CA
94115-4005
US

V. Phone/Fax

Practice location:
  • Phone: 415-292-1344
  • Fax:
Mailing address:
  • Phone: 415-292-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number219747
License Number StateCA

VIII. Authorized Official

Name: MRS. LANNIE ADELMAN HEANEY
Title or Position: NURSE MANAGER
Credential: RN
Phone: 415-657-1747