Healthcare Provider Details

I. General information

NPI: 1477721702
Provider Name (Legal Business Name): PATRICIA ANNE DEMOOR PA-C, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

1825 4TH ST FL STREET3
SAN FRANCISCO CA
94143-2350
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7070
  • Fax: 415-353-5050
Mailing address:
  • Phone: 415-353-7070
  • Fax: 415-353-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA17504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: