Healthcare Provider Details

I. General information

NPI: 1053655712
Provider Name (Legal Business Name): ROBERT JOSEPH PANDOLFE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 CALIFORNIA ST
SAN FRANCISCO CA
94115-2681
US

IV. Provider business mailing address

2410 CALIFORNIA ST
SAN FRANCISCO CA
94115-2681
US

V. Phone/Fax

Practice location:
  • Phone: 415-529-4050
  • Fax: 415-291-0489
Mailing address:
  • Phone: 415-529-4050
  • Fax: 415-291-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number22808
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: