Healthcare Provider Details

I. General information

NPI: 1790459857
Provider Name (Legal Business Name): HUMAN HEALTH OF NEVADA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 INNOVATION CAMPUS WAY
NEW ALBANY OH
43054
US

IV. Provider business mailing address

2269 CHESTNUT ST # 523
SAN FRANCISCO CA
94123-2600
US

V. Phone/Fax

Practice location:
  • Phone: 415-851-0195
  • Fax:
Mailing address:
  • Phone: 415-851-0195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CARRIE KOCEN
Title or Position: CREDENTIALING
Credential:
Phone: 415-851-0195