Provider Demographics
NPI:1881258440
Name:MESTAYER, JORGE M (MHW)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:M
Last Name:MESTAYER
Suffix:
Gender:M
Credentials:MHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 MADRID ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3545
Mailing Address - Country:US
Mailing Address - Phone:415-286-8149
Mailing Address - Fax:
Practice Address - Street 1:3905 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1014
Practice Address - Country:US
Practice Address - Phone:415-337-2400
Practice Address - Fax:415-337-2415
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty