Healthcare Provider Details

I. General information

NPI: 1932206364
Provider Name (Legal Business Name): PARKSIDE FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 OCEAN AVE STE 1
SAN FRANCISCO CA
94127-2605
US

IV. Provider business mailing address

2325 OCEAN AVE STE 1
SAN FRANCISCO CA
94127-2605
US

V. Phone/Fax

Practice location:
  • Phone: 415-452-2000
  • Fax: 415-452-2001
Mailing address:
  • Phone: 415-452-2000
  • Fax: 415-452-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIE LEWANDOWSKI
Title or Position: SECRETARY
Credential:
Phone: 415-452-2000