Healthcare Provider Details

I. General information

NPI: 1346783974
Provider Name (Legal Business Name): CHRISTINE MICULOB AINZA AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

400 PARNASSUS AVE
SAN FRANCISCO CA
94143-2202
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7500
  • Fax: 415-353-2889
Mailing address:
  • Phone: 415-353-7500
  • Fax: 415-353-2889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95005452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: