Provider Demographics
NPI:1881094217
Name:DIOSDADO, ISRAEL DE JESUS (HEALTH WORKER II)
Entity type:Individual
Prefix:
First Name:ISRAEL
Middle Name:DE JESUS
Last Name:DIOSDADO
Suffix:
Gender:M
Credentials:HEALTH WORKER II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3104
Mailing Address - Country:US
Mailing Address - Phone:415-401-2700
Mailing Address - Fax:415-401-2741
Practice Address - Street 1:2712 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3104
Practice Address - Country:US
Practice Address - Phone:415-401-2700
Practice Address - Fax:415-401-2741
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
CACPT 00019019246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACPT 00019019OtherSTATE LISCENCE PHLEBOTOMIST