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NPI Code Detail

MEDICARE: EDGAR GOMINTONG MANUEL APRN

MEDICARE: EDGAR GOMINTONG MANUEL APRN
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
1363L00000XNurse Practitioner95028616CA
2363L00000XNurse PractitionerAPRN-2328HI

General Provider Information

NPI Number : 1255841516
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDGAR GOMINTONG MANUEL APRN
Provider Business Mailing Address
First Line : 1 EMBARCADERO CTR STE 1900
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94111-3723
Country : US
Telephone Number : 415-658-6791
Fax Number :
Provider Business Practice Location Address
First Line : 900 VETERANS BLVD STE 150
Second Line :
City : REDWOOD CITY
State : CA
Zip : 94063-1741
Country : US
Telephone Number : 888-663-6331
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2017
Last Update Date : 04/16/2024

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