Healthcare Provider Details

I. General information

NPI: 1386864346
Provider Name (Legal Business Name): CITY & COUNTY OF SAN FRANCISCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 SOUTH VAN NESS AVENUE
SAN FRANCISCO CA
94110-1908
US

IV. Provider business mailing address

759 SOUTH VAN NESS AVENUE
SAN FRANCISCO CA
94110-1908
US

V. Phone/Fax

Practice location:
  • Phone: 415-642-4550
  • Fax: 415-695-6963
Mailing address:
  • Phone: 415-695-6955
  • Fax: 415-695-6963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHONA G. BAUTISTA-PERALTA
Title or Position: COMPLIANCE OFFICER
Credential: LCSW
Phone: 415-255-3443