Provider Demographics
NPI:1508157108
Name:SAN FRANCISCO BAY NUTRITION, LLC
Entity Type:Organization
Organization Name:SAN FRANCISCO BAY NUTRITION, LLC
Other - Org Name:SAN FRANCISCO NUTRITION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NORNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:FERRARA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:415-640-0554
Mailing Address - Street 1:1 SHRADER ST
Mailing Address - Street 2:600
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1016
Mailing Address - Country:US
Mailing Address - Phone:415-666-3220
Mailing Address - Fax:415-379-6766
Practice Address - Street 1:1 SHRADER ST
Practice Address - Street 2:600
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1016
Practice Address - Country:US
Practice Address - Phone:415-666-3220
Practice Address - Fax:415-379-6766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA953569261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center