Healthcare Provider Details

I. General information

NPI: 1538767009
Provider Name (Legal Business Name): ANDREA MICHELE CEVINI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 4TH ST FL 3
SAN FRANCISCO CA
94143-2351
US

IV. Provider business mailing address

237 SONDRA WAY
CAMPBELL CA
95008-1803
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1565
  • Fax:
Mailing address:
  • Phone: 305-542-2442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number95005704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: