Healthcare Provider Details

I. General information

NPI: 1649288697
Provider Name (Legal Business Name): NATHAN MORELLO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 MISSION RD SUITE C
SOUTH SAN FRANCISCO CA
94080-1302
US

IV. Provider business mailing address

1177 MISSION RD SUITE C
SOUTH SAN FRANCISCO CA
94080-1302
US

V. Phone/Fax

Practice location:
  • Phone: 650-225-9900
  • Fax: 650-225-9905
Mailing address:
  • Phone: 650-225-9900
  • Fax: 650-225-9905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033493
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: