| Desicouch | |
|
61 Airport Blvd. Ste. C South San Francisco CA 94080 | |
| (415) 267-4850 | |
| (415) 267-4850 |
| Full Name | Desicouch |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 61 Airport Blvd., South San Francisco, California |
| Authorized Official Name and Position | Desdemonia Whittle (PRESIDENT) |
| Authorized Official Contact | 4152674850 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Desicouch 61 Airport Blvd Ste. C South San Francisco CA 94080-6522 Ph: (415) 267-4850 | Desicouch 61 Airport Blvd. Ste. C South San Francisco CA 94080 Ph: (415) 267-4850 |
| NPI Number | 1053633198 |
|---|---|
| Provider Enumeration Date | 02/17/2010 |
| Last Update Date | 12/17/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053633198 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 43971 (California) | Primary |
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