Healthcare Provider Details

I. General information

NPI: 1942448261
Provider Name (Legal Business Name): CHRISTIAN MICHAEL MCNEILL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 CESAR CHAVEZ
SAN FRANCISCO CA
94110-4403
US

IV. Provider business mailing address

459 MCAULEY ST
OAKLAND CA
94609-1546
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-6000
  • Fax:
Mailing address:
  • Phone: 415-407-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: