Healthcare Provider Details

I. General information

NPI: 1851896336
Provider Name (Legal Business Name): ADIR MAGIDISH FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PHILLIPS DR
SAUSALITO CA
94965-1172
US

IV. Provider business mailing address

100 PHILLIPS DR
SAUSALITO CA
94965-1172
US

V. Phone/Fax

Practice location:
  • Phone: 415-339-8813
  • Fax: 415-339-8814
Mailing address:
  • Phone: 415-339-8813
  • Fax: 415-339-8814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95033722
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: