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General NPI Number Information
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NPI Number | 1588238497
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Entity Type | Organization
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Legal Business Name | LYON-MARTIN COMMUNITY HEALTH SERVICES
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Dates
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Enumeration Date | 05/14/2021
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Last Update Date | 05/14/2021
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Provider Practice Location Address
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Address Line | 1735 MISSION ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-2417
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Country | US
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Telephone | 415-565-7667
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Fax | 415-252-7512
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Provider Business Mailing Address
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Address Line | 1735 MISSION ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-2417
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Country | US
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Telephone | 415-565-7667
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Fax | 415-252-7512
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Authorized Official
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Title or Position | CEO
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Name | JACKSON JAMES MILLER JAFFE
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Credential |
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Telephone | 415-901-7108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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