Provider Demographics
NPI:1184015950
Name:DANRIDGE, KRYSTLE SHEREE
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:SHEREE
Last Name:DANRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-2758
Mailing Address - Country:US
Mailing Address - Phone:415-822-5977
Mailing Address - Fax:415-671-1042
Practice Address - Street 1:1601 QUESADA AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-2334
Practice Address - Country:US
Practice Address - Phone:415-822-5977
Practice Address - Fax:415-671-1042
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator