Healthcare Provider Details

I. General information

NPI: 1245988161
Provider Name (Legal Business Name): EMANUELLE VASCONCELOS B BORBA PONTUAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMANUELLE VASCONCELOS

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE STE A501
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

400 PARNASSUS AVE STE A501
SAN FRANCISCO CA
94143-2202
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1606
  • Fax:
Mailing address:
  • Phone: 415-353-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95020243
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95020243
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: