Healthcare Provider Details

I. General information

NPI: 1639214638
Provider Name (Legal Business Name): JEFFREY TAYAG N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 SACRAMENTO ST
SAN FRANCISCO CA
94118-1625
US

IV. Provider business mailing address

53 MECARTNEY RD
ALAMEDA CA
94502-6910
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-2430
  • Fax: 415-600-6304
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: