1508848714 NPI number — MS. MARY JOCELYN PORQUEZ FNP, CNS, APRN-BC

Table of content: MS. MARY JOCELYN PORQUEZ FNP, CNS, APRN-BC (NPI 1508848714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508848714 NPI number — MS. MARY JOCELYN PORQUEZ FNP, CNS, APRN-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORQUEZ
Provider First Name:
MARY
Provider Middle Name:
JOCELYN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP, CNS, APRN-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PORQUEZ
Provider Other First Name:
JOCELYN
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP, CS, APRN-BC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1508848714
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
760 HARRISON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94107-1235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-836-1700
Provider Business Mailing Address Fax Number:
415-836-1737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
760 HARRISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94107-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-836-1700
Provider Business Practice Location Address Fax Number:
415-836-1737
Provider Enumeration Date:
11/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  NP17206 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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