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NPI Code Detail

MEDICARE: TENGIZ IOSEBASHVILI

MEDICARE: TENGIZ IOSEBASHVILI
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
1332B00000XDurable Medical Equipment & Medical Supplies916545CA

Other Identifiers

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

General Provider Information

NPI Number : 1376557629
Entity Type Code : Organization
Provider Name (Legal Business Name) : TENGIZ IOSEBASHVILI
Provider Business Mailing Address
First Line : 1024 MISSION ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94103-2813
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1024 MISSION ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94103-2813
Country : US
Telephone Number : 415-431-9900
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MR. TENGIZ IOSEBASHVILI
Credential :
Telephone Number : 415-431-9900
Provider Enumeration Date : 07/29/2006
Last Update Date : 06/26/2008

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Directions to “TENGIZ IOSEBASHVILI ” Practice Location

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