MEDICARE: MS. AVIS M THOMPSON

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1972849057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AVIS M THOMPSON

Provider Business Mailing Address
First Line	:	522 CARTER ST
Second Line	:	APT 301A
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94134-3188
Country	:	US
Telephone Number	:	415-793-6333
Fax Number	:

Provider Business Practice Location Address
First Line	:	522 CARTER ST
Second Line	:	APT 301A
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94134-3188
Country	:	US
Telephone Number	:	415-793-6333
Fax Number	:

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

Provider Enumeration Date	:	12/18/2012
Last Update Date	:	12/18/2012

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