Provider Demographics
NPI:1356643654
Name:ST ANTHONY FOUNDATION
Entity Type:Organization
Organization Name:ST ANTHONY FOUNDATION
Other - Org Name:ST ANTHONY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-592-2712
Mailing Address - Street 1:150 GOLDEN GATE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3810
Mailing Address - Country:US
Mailing Address - Phone:415-241-8320
Mailing Address - Fax:415-440-7776
Practice Address - Street 1:150 GOLDEN GATE AVE FL 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3810
Practice Address - Country:US
Practice Address - Phone:415-241-8320
Practice Address - Fax:415-440-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA220000400261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty