Provider Demographics
NPI:1225452147
Name:LAIWA, JANINE
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:LAIWA
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 1:3850 17TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-2031
Mailing Address - Country:US
Mailing Address - Phone:415-934-7702
Mailing Address - Fax:415-934-7742
Practice Address - Street 1:3850 17TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2031
Practice Address - Country:US
Practice Address - Phone:415-934-7702
Practice Address - Fax:415-934-7742
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker