=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427453323
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIMO HEALTH COACH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2014
-----------------------------------------------------
Last Update Date | 11/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2460 MISSION ST STE 214
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94110-2458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-754-3047
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 401195
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94140-1195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-754-3047
-----------------------------------------------------
Fax | 415-358-5619
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CLINICAL NUTRITIONIST
-----------------------------------------------------
Name | DANIEL SANELLI
-----------------------------------------------------
Credential | M.SC.
-----------------------------------------------------
Telephone | 415-754-3047
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------