Healthcare Provider Details

I. General information

NPI: 1588230809
Provider Name (Legal Business Name): STEPHANIE ANN CORDONNIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 GEARY BLVD FL 1
SAN FRANCISCO CA
94118-3212
US

IV. Provider business mailing address

490 ILLINOIS ST
SAN FRANCISCO CA
94143-2510
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLP05346
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA198072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: