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General NPI Number Information
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NPI Number | 1922361385
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Entity Type | Organization
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Legal Business Name | AXIOM MEDICAL GROUP A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 1700 CALIFORNIA ST SUITE 520
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City | SAN FRANCISCO
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State | CA
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Zip | 94109-4586
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Country | US
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Telephone | 415-345-0099
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Fax | 415-345-0059
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Provider Business Mailing Address
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Address Line | 1700 CALIFORNIA ST SUITE 520
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City | SAN FRANCISCO
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State | CA
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Zip | 94109-4586
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Country | US
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Telephone | 415-345-0099
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Fax | 415-345-0059
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | AHVIE HERSKOWITZ
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Credential | M.D.
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Telephone | 415-345-0099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | C50117
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C50117
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License Number State | CA
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