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General NPI Number Information
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NPI Number | 1679892863
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Entity Type | Individual
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Provider Name | MS. CHANTELLE MABASA MADAYAG
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Gender | Female
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 05/27/2010
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Provider Practice Location Address
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Address Line | 52 DORE ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-3828
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Country | US
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Telephone | 415-553-3100
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Fax | 415-553-3119
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Provider Business Mailing Address
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Address Line | 368 FELL ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94102-5144
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Country | US
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Telephone | 415-861-0828
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Fax | 415-861-0257
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | VN248651
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License Number State | CA
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