Provider Demographics
NPI:1619172111
Name:PRIDE, MICHEL'LA C
Entity Type:Individual
Prefix:MS
First Name:MICHEL'LA
Middle Name:C
Last Name:PRIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 MADDUX AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-2212
Mailing Address - Country:US
Mailing Address - Phone:415-933-1563
Mailing Address - Fax:
Practice Address - Street 1:2500 18TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2109
Practice Address - Country:US
Practice Address - Phone:415-546-6756
Practice Address - Fax:415-546-6778
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator