Healthcare Provider Details

I. General information

NPI: 1932982196
Provider Name (Legal Business Name): RAZA MOREAU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 KORET WAY
SAN FRANCISCO CA
94143-2218
US

IV. Provider business mailing address

2 KORET WAY
SAN FRANCISCO CA
94143-2218
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1435
  • Fax:
Mailing address:
  • Phone: 415-476-1435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95026629
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95026629
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number95026629
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95026629
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95026629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: