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General NPI Number Information
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NPI Number | 1265791891
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Entity Type | Individual
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Provider Name | SUN CAPTAIN PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3031 TELEGRAPH AVE STE 217
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City | BERKELEY
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State | CA
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Zip | 94705-2053
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Country | US
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Telephone | 510-981-8222
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Fax | 510-981-8228
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Provider Business Mailing Address
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Address Line | 601 VAN NESS AVE APT 52
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City | SAN FRANCISCO
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State | CA
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Zip | 94102-3263
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Country | US
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Telephone | 415-794-8441
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Fax | 510-981-8228
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA17206
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License Number State | CA
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