Provider Demographics
NPI:1053655712
Name:PANDOLFE, ROBERT JOSEPH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:PANDOLFE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2681
Mailing Address - Country:US
Mailing Address - Phone:415-529-4050
Mailing Address - Fax:415-291-0489
Practice Address - Street 1:2410 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2681
Practice Address - Country:US
Practice Address - Phone:415-529-4050
Practice Address - Fax:415-291-0489
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22808363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant