Provider Demographics
NPI:1629655790
Name:THOMPSON, PETRIA-GEORGE SALEWA (MD, PHD)
Entity Type:Individual
Prefix:
First Name:PETRIA-GEORGE
Middle Name:SALEWA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:PETRIA
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:450 STANYAN ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 STANYAN ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1019
Practice Address - Country:US
Practice Address - Phone:415-750-5942
Practice Address - Fax:415-750-5594
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program