Healthcare Provider Details

I. General information

NPI: 1174138044
Provider Name (Legal Business Name): MR. ANDREW LEIFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/09/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 HAYES ST
SAN FRANCISCO CA
94117-2615
US

IV. Provider business mailing address

890 HAYES ST
SAN FRANCISCO CA
94117-2615
US

V. Phone/Fax

Practice location:
  • Phone: 415-701-5100
  • Fax: 415-621-1033
Mailing address:
  • Phone: 415-701-5100
  • Fax: 415-621-1033

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: