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General NPI Number Information
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NPI Number | 1255961355
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Entity Type | Organization
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Legal Business Name | CRICKET HEALTH MEDICAL PRACTICE PC
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Dates
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Enumeration Date | 01/17/2020
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 548 MARKET STREET STE 39516
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City | SAN FRANCISCO
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State | CA
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Zip | 94104-4534
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Country | US
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Telephone | 833-644-8244
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Fax |
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Provider Business Mailing Address
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Address Line | 548 MARKET STREET PMB 39516
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City | SAN FRANCISCO
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State | CA
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Zip | 94104-4534
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Country | US
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Telephone | 833-644-8244
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JULIE DOMINGUEZ
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Credential | MD
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Telephone | 833-644-8244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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