Provider Demographics
NPI:1063445187
Name:STEVEN FUGARO MD
Entity Type:Organization
Organization Name:STEVEN FUGARO MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FUGARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-476-2752
Mailing Address - Street 1:350 PARNASSUS AVE
Mailing Address - Street 2:STE 710
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-3608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 PARNASSUS AVE
Practice Address - Street 2:STE 710
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-3608
Practice Address - Country:US
Practice Address - Phone:415-476-2752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48694207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51143Medicare UPIN