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General NPI Number Information
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NPI Number | 1013200112
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Entity Type | Organization
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Legal Business Name | EASTER SEALS CHILD DEVELOPMENT CENTER
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Dates
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Enumeration Date | 05/23/2011
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Last Update Date | 05/23/2011
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Provider Practice Location Address
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Address Line | 95 HAWTHORNE ST FL 1
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City | SAN FRANCISCO
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State | CA
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Zip | 94105-3917
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Country | US
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Telephone | 415-744-8754
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Fax | 415-744-8717
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Provider Business Mailing Address
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Address Line | 95 HAWTHORNE ST FL 1
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City | SAN FRANCISCO
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State | CA
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Zip | 94105-3917
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Country | US
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Telephone | 415-744-8754
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Fax | 415-744-8717
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Authorized Official
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Title or Position | PROGRAM SUPERVISOR
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Name | ROSALIE CINQUE
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Credential |
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Telephone | 415-744-8754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State | CA
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