MEDICARE: DEPT PUBLIC HEALTH

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	305S00000X	Point of Service

General Provider Information

NPI Number	:	1881021996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPT PUBLIC HEALTH

Provider Business Mailing Address
First Line	:	2443 FILLMORE ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2443 FILLMORE ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1814
Country	:	US
Telephone Number	:	415-685-7925
Fax Number	:

Authorized Official
Title or Position	:	HEALTH WORKER III
Name	:	MS. REMI IRVING
Credential	:
Telephone Number	:	415-685-7925

Provider Enumeration Date	:	10/03/2013
Last Update Date	:	10/03/2013

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