Healthcare Provider Details

I. General information

NPI: 1255303970
Provider Name (Legal Business Name): TERESA PHYLLIS JONES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA PHYLLIS FOSTER PA-C

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 BUSH ST SUITE 300
SAN FRANCISCO CA
94109-5999
US

IV. Provider business mailing address

3333 CALIFORNIA ST. S1-10
SAN FRANCISCO CA
94118-1981
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-6380
  • Fax: 415-353-6494
Mailing address:
  • Phone: 415-885-7268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA52284
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number104028
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: