Healthcare Provider Details

I. General information

NPI: 1588856462
Provider Name (Legal Business Name): MR. KUNJAL S. JOSHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1466 LINCOLN AVE
SAN RAFAEL CA
94901-2021
US

IV. Provider business mailing address

3450 3RD ST STE 1C
SAN FRANCISCO CA
94124-1444
US

V. Phone/Fax

Practice location:
  • Phone: 415-457-3755
  • Fax: 415-457-0849
Mailing address:
  • Phone: 415-437-3990
  • Fax: 415-437-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF73731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: