MEDICARE: THEORA BORDON CIMINO

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	207R00000X	Internal Medicine Physician	A162133	CA
2	2084P0800X	Psychiatry Physician	A162133	CA
3	208M00000X	Hospitalist Physician	A162133	CA

General Provider Information

NPI Number	:	1588197073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEORA BORDON CIMINO

Provider Business Mailing Address
First Line	:	1228 48TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1013
Country	:	US
Telephone Number	:	415-307-4526
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 PARNASSUS AVE RM M-987
Second Line	:	UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2204
Country	:	US
Telephone Number	:	415-476-1528
Fax Number	:

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

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	12/27/2023

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Directions to “ THEORA BORDON CIMINO ” Practice Location

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