Basic Information
| Provider Information | |||||||||
| NPI: | 1134256126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAGDORF | ||||||||
| FirstName: | BEVERLY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 POTRERO AVE # 1M | ||||||||
| Address2: | GENERAL MEDICAL CLINIC | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941103518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152068494 | ||||||||
| FaxNumber: | 4152066115 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 POTRERO AVE # 1M | ||||||||
| Address2: | GENERAL MEDICAL CLINIC | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941103518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152068494 | ||||||||
| FaxNumber: | 4152066115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP2201X | RN206859 | CA | X | Nursing Service Providers | Registered Nurse | Ambulatory Care | 363LF0000X | NPF10513 | CA | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 984955 | 01 | SFGH INTERNAL USE ONLY-COMMERCIAL NUMBER | OTHER |