Provider Demographics
NPI:1376214783
Name:MISSION AREA HEALTH ASSOCIATES, INC
Entity Type:Organization
Organization Name:MISSION AREA HEALTH ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-552-1013
Mailing Address - Street 1:240 SHOTWELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1323
Mailing Address - Country:US
Mailing Address - Phone:415-552-1013
Mailing Address - Fax:415-431-3178
Practice Address - Street 1:1580 VALENCIA ST STE 702
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4415
Practice Address - Country:US
Practice Address - Phone:866-961-8588
Practice Address - Fax:415-852-4058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)