Healthcare Provider Details

I. General information

NPI: 1770961187
Provider Name (Legal Business Name): PASSPORT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3117 GEARY BLVD
SAN FRANCISCO CA
94118-3316
US

IV. Provider business mailing address

8324 E HARTFORD DR
SCOTTSDALE AZ
85255-5466
US

V. Phone/Fax

Practice location:
  • Phone: 888-909-6551
  • Fax:
Mailing address:
  • Phone: 888-909-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VICTORIA SOWARDS
Title or Position: DIRECTOR OF NURSING RESOURCES
Credential:
Phone: 888-909-6551