Healthcare Provider Details

I. General information

NPI: 1245739283
Provider Name (Legal Business Name): GEORGE HOWARD HERZOG RN, CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CLEMENT ST G1-111B1
SAN FRANCISCO CA
94121
US

IV. Provider business mailing address

88 PALISADES DR
DALY CITY CA
94015-4511
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4810
  • Fax:
Mailing address:
  • Phone: 415-516-9852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number4606
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number4606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: