MEDICARE: ZONA KEO ASW

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	101Y00000X	Counselor	ASW63762	CA

General Provider Information

NPI Number	:	1114328770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZONA KEO ASW

Provider Business Mailing Address
First Line	:	1 SAINT VINCENTS DR
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-1504
Country	:	US
Telephone Number	:	415-507-4203
Fax Number	:	415-491-0842

Provider Business Practice Location Address
First Line	:	823 EUCLID AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-2510
Country	:	US
Telephone Number	:	415-610-1649
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2014
Last Update Date	:	04/20/2016

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Directions to “ ZONA KEO ASW” Practice Location

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