Provider Demographics
NPI:1639676752
Name:ORBETA, JOSE LUIS
Entity Type:Individual
Prefix:MR
First Name:JOSE LUIS
Middle Name:
Last Name:ORBETA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 HOWARD ST # 423B
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2638
Mailing Address - Country:US
Mailing Address - Phone:415-255-3941
Mailing Address - Fax:415-255-3798
Practice Address - Street 1:1282 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4801
Practice Address - Country:US
Practice Address - Phone:415-579-3021
Practice Address - Fax:415-941-7313
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker