Provider Demographics
NPI:1205953676
Name:FRANICEVICH, JAMES JOSEPH (NP)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JOSEPH
Last Name:FRANICEVICH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LECH WALESA
Mailing Address - Street 2:TOM WADDELL CLINIC
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4506
Mailing Address - Country:US
Mailing Address - Phone:415-355-7425
Mailing Address - Fax:415-355-7401
Practice Address - Street 1:50 LECH WALESA
Practice Address - Street 2:TOM WADDELL CLINIC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4506
Practice Address - Country:US
Practice Address - Phone:415-355-7425
Practice Address - Fax:415-355-7401
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17416363A00000X
CA343801363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
984724OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
NPXUXUMedicare UPIN