Provider Demographics
NPI:1780367144
Name:APPEDU, ANTHONY JR
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:APPEDU
Suffix:JR
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 1:2051 SHORELINE DR APT 104
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6158
Mailing Address - Country:US
Mailing Address - Phone:415-713-3927
Mailing Address - Fax:
Practice Address - Street 1:1360 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2626
Practice Address - Country:US
Practice Address - Phone:628-217-7747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136277106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist