Provider Demographics
NPI:1366013500
Name:BADRA, PABLO
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:
Last Name:BADRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 POLK ST FL 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-7813
Mailing Address - Country:US
Mailing Address - Phone:415-662-3342
Mailing Address - Fax:
Practice Address - Street 1:730 POLK ST FL 4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-7813
Practice Address - Country:US
Practice Address - Phone:415-662-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker