Provider Demographics
NPI:1013593912
Name:MISSION AREA HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:MISSION AREA HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-552-1013
Mailing Address - Street 1:240 SHOTWELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1323
Mailing Address - Country:US
Mailing Address - Phone:415-552-1013
Mailing Address - Fax:415-431-3178
Practice Address - Street 1:1580 VALENCIA ST STE 506
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4418
Practice Address - Country:US
Practice Address - Phone:415-852-4080
Practice Address - Fax:415-431-3178
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSION AREA HEALTH ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)