Provider Demographics
NPI:1396418190
Name:CONCUSSION AND MIGRAINE CLINIC
Entity Type:Organization
Organization Name:CONCUSSION AND MIGRAINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:AZULAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-673-5700
Mailing Address - Street 1:815 HYDE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5996
Mailing Address - Country:US
Mailing Address - Phone:415-673-5700
Mailing Address - Fax:415-292-7140
Practice Address - Street 1:815 HYDE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5996
Practice Address - Country:US
Practice Address - Phone:415-673-5700
Practice Address - Fax:415-292-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health