Healthcare Provider Details

I. General information

NPI: 1023848868
Provider Name (Legal Business Name): MS. ISABELLA MARTA NICOLAS LEGARDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 03/25/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 POST STREET COMMUNITY YOUTH CENTER
SAN FRANCISCO CA
94109
US

IV. Provider business mailing address

1038 POST STREET COMMUNITY YOUTH CENTER
SAN FRANCISCO CA
94109
US

V. Phone/Fax

Practice location:
  • Phone: 415-775-2636
  • Fax:
Mailing address:
  • Phone: 415-775-2636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: