=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972747095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTHONY COSENTINO MD A PROFESSIONAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2009
-----------------------------------------------------
Last Update Date | 05/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 STANYAN ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94117-1019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-750-5688
-----------------------------------------------------
Fax | 415-750-8149
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1023
-----------------------------------------------------
City | NOVATO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94948-1023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-234-6100
-----------------------------------------------------
Fax | 415-234-6500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL BILLER
-----------------------------------------------------
Name | LINDA PERAZZO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-234-6100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 00A177340
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------