Healthcare Provider Details

I. General information

NPI: 1992223069
Provider Name (Legal Business Name): AMBILI N THANNIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 16TH STREET 5TH FLOOR
SAN FRANCISCO CA
94158
US

IV. Provider business mailing address

550 16TH ST FL 5
SAN FRANCISCO CA
94158-2545
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-5153
  • Fax:
Mailing address:
  • Phone: 415-476-5153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number95007211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: