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General NPI Number Information
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NPI Number | 1760881858
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Entity Type | Organization
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Legal Business Name | SANFRANSKINNY
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 11100 SAN PABLO AVE 104
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City | EL CERRITO
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State | CA
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Zip | 94530-2194
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Country | US
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Telephone | 415-383-9903
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Fax | 415-383-9901
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Provider Business Mailing Address
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Address Line | 11100 SAN PABLO AVE 104
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City | EL CERRITO
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State | CA
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Zip | 94530-2194
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Country | US
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Telephone | 415-383-9903
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Fax | 415-383-9901
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Authorized Official
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Title or Position | OWNER
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Name | MORGAN CAMP
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Credential | M.D.
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Telephone | 415-383-9903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 132700000X
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Taxonomy Name | Dietary Manager
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License Number |
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License Number State | CA
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