Healthcare Provider Details

I. General information

NPI: 1821876418
Provider Name (Legal Business Name): KUNANI TUTTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CASTRO ST STE 410
SAN FRANCISCO CA
94114-1027
US

IV. Provider business mailing address

190 E OKEEFE ST APT 17
MENLO PARK CA
94025-2651
US

V. Phone/Fax

Practice location:
  • Phone: 415-565-6884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: