Healthcare Provider Details

I. General information

NPI: 1881320844
Provider Name (Legal Business Name): EDITH TCHIKANDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 VAN NESS AVE
SAN FRANCISCO CA
94102-6041
US

IV. Provider business mailing address

77 VAN NESS AVE
SAN FRANCISCO CA
94102-6041
US

V. Phone/Fax

Practice location:
  • Phone: 408-837-0116
  • Fax:
Mailing address:
  • Phone: 408-837-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCN0030063515
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: