Provider Demographics
NPI:1497883276
Name:TOM WADDELL HEALTH CENTER
Entity Type:Organization
Organization Name:TOM WADDELL HEALTH CENTER
Other - Org Name:SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STUKALIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCSW
Authorized Official - Phone:415-355-7512
Mailing Address - Street 1:50 LECH WALESA ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SAN FRANCSICO
Mailing Address - State:CA
Mailing Address - Zip Code:94102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 LECH WALESA
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4506
Practice Address - Country:US
Practice Address - Phone:415-355-7512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20715261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local