Healthcare Provider Details

I. General information

NPI: 1003700204
Provider Name (Legal Business Name): BETHANY SIEFFERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 POST ST STE 270
SAN FRANCISCO CA
94115-3466
US

IV. Provider business mailing address

4128 E 3RD AVE
NAPA CA
94558-4043
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2101
  • Fax:
Mailing address:
  • Phone: 650-798-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number20234
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: