| Westside Community Services | |
|
245 11th St San Francisco CA 94103-3732 | |
| (415) 355-0311 | |
| (415) 355-0349 |
| Full Name | Westside Community Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 245 11th St, San Francisco, California |
| Authorized Official Name and Position | Mary Ann Jones (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 4154319000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Westside Community Services 1153 Oak St San Francisco CA 94117-2216 Ph: (415) 431-9000 | Westside Community Services 245 11th St San Francisco CA 94103-3732 Ph: (415) 355-0311 |
| NPI Number | 1437215233 |
|---|---|
| Provider Enumeration Date | 12/28/2006 |
| Last Update Date | 05/26/2021 |
| Certification Date | 05/26/2021 |
| Medicare PECOS PAC ID | 9436204427 |
|---|---|
| Medicare Enrollment ID | O20090826000770 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437215233 | NPI | - | NPPES |
| 8976 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Raymond P Moczulski |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255497962 PECOS PAC ID: 5799885174 Enrollment ID: I20070713000751 |
| Provider Name | Lucy D Hsu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013188333 PECOS PAC ID: 9234284118 Enrollment ID: I20090827000819 |
| Provider Name | Lauren Enteen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801224217 PECOS PAC ID: 4082912498 Enrollment ID: I20160419001885 |
| Provider Name | Jonathan S Olson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356612071 PECOS PAC ID: 5698054542 Enrollment ID: I20161116001624 |
| Provider Name | Kathleen Gilligan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962834150 PECOS PAC ID: 2365725728 Enrollment ID: I20170208002032 |
| Provider Name | Napoleon Deveyra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639428659 PECOS PAC ID: 2365725298 Enrollment ID: I20180829003050 |
| Provider Name | Benjamin Anjo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902327075 PECOS PAC ID: 3072930809 Enrollment ID: I20200825003053 |
| Provider Name | Ethan Glenn Huffman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609473735 PECOS PAC ID: 6204256100 Enrollment ID: I20201014002933 |
| Provider Name | Emmanuel Odiwuor Onywera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821461286 PECOS PAC ID: 7719364975 Enrollment ID: I20220510001459 |
| Provider Name | Noah Seth Bonneville |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255460952 PECOS PAC ID: 3779951249 Enrollment ID: I20221115002119 |
| Provider Name | Juliano Innocenti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306258314 PECOS PAC ID: 0446628333 Enrollment ID: I20221128000981 |
| Provider Name | Whitney Dalious Bagby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669989752 PECOS PAC ID: 5092178749 Enrollment ID: I20230828003270 |
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