Healthcare Provider Details

I. General information

NPI: 1285938662
Provider Name (Legal Business Name): MISSION AREA HEALTH ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 VALENCIA ST
SAN FRANCISCO CA
94110-5012
US

IV. Provider business mailing address

240 SHOTWELL ST
SAN FRANCISCO CA
94110-1323
US

V. Phone/Fax

Practice location:
  • Phone: 415-647-3666
  • Fax:
Mailing address:
  • Phone: 415-552-3870
  • Fax: 415-552-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SILVIA SIU
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 415-552-3870