Healthcare Provider Details

I. General information

NPI: 1538098975
Provider Name (Legal Business Name): JEREMY HAGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 D ST
SAN RAFAEL CA
94901-3719
US

IV. Provider business mailing address

812 D ST
SAN RAFAEL CA
94901-2814
US

V. Phone/Fax

Practice location:
  • Phone: 415-454-9444
  • Fax:
Mailing address:
  • Phone: 415-454-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number22636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: