Healthcare Provider Details

I. General information

NPI: 1285545285
Provider Name (Legal Business Name): PORTOLA MGMT BSD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 UNIVERSITY ST
SAN FRANCISCO CA
94134-1635
US

IV. Provider business mailing address

350 UNIVERSITY ST
SAN FRANCISCO CA
94134-1635
US

V. Phone/Fax

Practice location:
  • Phone: 212-624-2776
  • Fax:
Mailing address:
  • Phone: 212-624-2776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: NADAV ICHAKI
Title or Position: OWNER
Credential:
Phone: 212-624-2776