MEDICARE: TIDES CENTERINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	220000401	CA
2	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093709206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIDES CENTERINIC

Provider Business Mailing Address
First Line	:	1833 FILLIMORE ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115
Country	:	US
Telephone Number	:	415-379-7800
Fax Number	:	415-379-7804

Provider Business Practice Location Address
First Line	:	1833 FILLIMORE ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115
Country	:	US
Telephone Number	:	415-379-7800
Fax Number	:	415-379-7804

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CARLINA F. HANSEN
Credential	:
Telephone Number	:	415-379-7800

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	03/12/2013

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Directions to “TIDES CENTERINIC ” Practice Location

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