MEDICARE: NICOLE AMBROSIO PPSC

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	1041S0200X	School Social Worker	230112166	CA
2	104100000X	Social Worker		CA

General Provider Information

NPI Number	:	1689538142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE AMBROSIO PPSC

Provider Business Mailing Address
First Line	:	1515 QUINTARA ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-1273
Country	:	US
Telephone Number	:	415-242-2615
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 EXCELSIOR AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-2041
Country	:	US
Telephone Number	:	415-469-4739
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ NICOLE AMBROSIO PPSC” Practice Location

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