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NPI Code Detail

MEDICARE: MR. LUIS VENEGAS

MEDICARE: MR. LUIS VENEGAS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1205034345
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LUIS VENEGAS
Provider Business Mailing Address
First Line : 301 GRAND AVE STE 301
Second Line :
City : SOUTH SAN FRANCISCO
State : CA
Zip : 94080-3641
Country : US
Telephone Number : 650-244-1444
Fax Number : 650-244-1447
Provider Business Practice Location Address
First Line : 301 GRAND AVE STE 301
Second Line :
City : SOUTH SAN FRANCISCO
State : CA
Zip : 94080-3641
Country : US
Telephone Number : 650-244-1444
Fax Number : 650-244-1447
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2007
Last Update Date : 01/23/2008

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