Healthcare Provider Details

I. General information

NPI: 1851941298
Provider Name (Legal Business Name): JAMES SARDELIS AGPCNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

527 SANCHEZ ST
SAN FRANCISCO CA
94114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7500
  • Fax:
Mailing address:
  • Phone: 619-517-6659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95012744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: