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General NPI Number Information
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NPI Number | 1457357618
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Entity Type | Individual
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Provider Name | JUDY D MAMACLAY MD
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Gender | Female
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 03/15/2025
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Provider Practice Location Address
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Address Line | 4131 GEARY BLVD
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City | SAN FRANCISCO
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State | CA
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Zip | 94118-3101
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Country | US
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Telephone | 415-418-9114
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Fax |
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Provider Business Mailing Address
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Address Line | 4131 GEARY BLVD
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City | SAN FRANCISCO
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State | CA
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Zip | 94118-3101
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Country | US
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Telephone | 415-418-9114
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Fax |
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 040859
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License Number State | CT
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