Healthcare Provider Details

I. General information

NPI: 1740399559
Provider Name (Legal Business Name): CITY & COUNTY OF SAN FRANCISCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 MISSION STREET
SAN FRANCISCO CA
94110
US

IV. Provider business mailing address

1380 HOWARD ST 5TH FLOOR
SAN FRANCISCO CA
94103-2638
US

V. Phone/Fax

Practice location:
  • Phone: 415-401-2700
  • Fax: 415-401-2741
Mailing address:
  • Phone: 415-255-3699
  • Fax: 415-252-3015

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