Healthcare Provider Details

I. General information

NPI: 1083940969
Provider Name (Legal Business Name): TIDES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 TORNEY AVE
SAN FRANCISCO CA
94129-1755
US

IV. Provider business mailing address

1014 TORNEY AVE
SAN FRANCISCO CA
94129-1755
US

V. Phone/Fax

Practice location:
  • Phone: 415-561-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. ALVIN LEE
Title or Position: GOVERNMENT GRANTS MANAGER
Credential:
Phone: 415-561-6309