Provider Demographics
NPI:1720734759
Name:PIERCE, CHARLESTON
Entity Type:Individual
Prefix:
First Name:CHARLESTON
Middle Name:
Last Name:PIERCE
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 1:1130 HOLLISTER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-3634
Mailing Address - Country:US
Mailing Address - Phone:415-215-1500
Mailing Address - Fax:
Practice Address - Street 1:1638 KIRKWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-2137
Practice Address - Country:US
Practice Address - Phone:415-215-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist