Basic Information
| Provider Information | |||||||||
| NPI: | 1952532053 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MOUNT SAINT JOSEPH AND ELIZABETH | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MASONIC AVE | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941184415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155678370 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 MASONIC AVE | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941184415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155678370 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2009 | ||||||||
| LastUpdateDate: | 08/06/2009 | ||||||||
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| AuthorizedOfficialLastName: | WOODS | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | MFTI | ||||||||
| AuthorizedOfficialTelephone: | 5102511033 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.A. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | CA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1952449316 | 01 | CA | MEDICAL | OTHER |