Healthcare Provider Details

I. General information

NPI: 1962763821
Provider Name (Legal Business Name): CEDRIC DUNN SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GRAND AVE STE 301
SOUTH SAN FRANCISCO CA
94080-3641
US

IV. Provider business mailing address

301 GRAND AVE STE 301
SOUTH SAN FRANCISCO CA
94080-3641
US

V. Phone/Fax

Practice location:
  • Phone: 650-244-1444
  • Fax:
Mailing address:
  • Phone: 650-244-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: