Healthcare Provider Details

I. General information

NPI: 1972566693
Provider Name (Legal Business Name): JUDITH P DADDIO PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 CALIFORNIA ST CHILD DEVELOPMENT CENTER, 1ST FLOOR
SAN FRANCISCO CA
94118-1618
US

IV. Provider business mailing address

863 VERMONT ST
SAN FRANCISCO CA
94107-2614
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-0830
  • Fax:
Mailing address:
  • Phone: 415-550-6860
  • Fax: 415-229-4782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number171771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: