Provider Demographics
NPI:1710522123
Name:BADAGLIACCO, JOHN (MS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BADAGLIACCO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1516
Mailing Address - Country:US
Mailing Address - Phone:715-699-0970
Mailing Address - Fax:
Practice Address - Street 1:2130 FULTON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1050
Practice Address - Country:US
Practice Address - Phone:415-422-4061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000012256OtherBOC CERTIFICATION