MEDICARE: DR. CAROLYN J MANNON MD

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	207V00000X	Obstetrics & Gynecology Physician	A75180	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MMM00087M	OTHER	CA	NHIC

General Provider Information

NPI Number	:	1174587810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN J MANNON MD

Provider Business Mailing Address
First Line	:	PO BOX 60000
Second Line	:	FILE 72484
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94160-0001
Country	:	US
Telephone Number	:	650-498-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2356 SUTTER ST STE J-140
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3006
Country	:	US
Telephone Number	:	415-885-7788
Fax Number	:	415-353-9551

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	12/02/2022

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