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1625 Carroll Ave San Francisco CA 94124-3219 | |
| (415) 468-5100 | |
| (415) 469-5104 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1625 Carroll Ave, San Francisco, California |
| Authorized Official Name and Position | James Bouquin (CEO) |
| Authorized Official Contact | 4154685100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1625 Carroll Ave San Francisco CA 94124-3219 Ph: (415) 468-5100 | 1625 Carroll Ave San Francisco CA 94124-3219 Ph: (415) 468-5100 |
| NPI Number | 1053477315 |
|---|---|
| Provider Enumeration Date | 12/29/2006 |
| Last Update Date | 03/19/2024 |
| Certification Date | 03/19/2024 |
| Medicare PECOS PAC ID | 5597055152 |
|---|---|
| Medicare Enrollment ID | O20160609002324 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053477315 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (California) | Primary |
| Provider Name | Ruth Urbitztondo Deperalta |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093839813 PECOS PAC ID: 3476590407 Enrollment ID: I20050412000526 |
| Provider Name | Jennifer Emily Annunziata |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609959683 PECOS PAC ID: 8729015722 Enrollment ID: I20050721000272 |
| Provider Name | Kimberly Yano |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457839508 PECOS PAC ID: 5597171009 Enrollment ID: I20210330000726 |
| Provider Name | Ross Talbot Quinn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871082602 PECOS PAC ID: 4082097084 Enrollment ID: I20220823002741 |
| Provider Name | Eric Anthony Lee |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1376979989 PECOS PAC ID: 1052847407 Enrollment ID: I20241209001277 |
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