=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104949916
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRENCE EDWARD ARAGONI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 FRANCISCO ST SUITE 440
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94133-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-433-3434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 655 KELMORE ST
-----------------------------------------------------
City | MOSS BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94038-9709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-728-3223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | G66555
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------