# HEADQUARTERS MEDICAL GROUP WEST PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154289833
- **Authorized official:** LUCAS JOHNSTON (OPERATIONS ADMINISTRATOR)
- **Authorized official phone:** (415) 763-5790

## Contact information

- **Practice address:** 1417 15TH ST, SAN FRANCISCO, CA 94103-3623
- **Practice address phone:** (415) 763-5790
- **Mailing address:** 1417 15TH ST, SAN FRANCISCO, CA 94103-3623

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | Yes |
| 2080S0010X | Pediatric Sports Medicine Physician | — | NULL | — |
| 2080S0010X | Pediatric Sports Medicine Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 2081P0301X | Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081P0301X | Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |
| 2084N0400X | Neurology Physician | — | NULL | — |
| 2084N0400X | Neurology Physician | — | — | — |
| 2084P0301X | Brain Injury Medicine (Psychiatry & Neurology) Physician | — | NULL | — |
| 2084P0301X | Brain Injury Medicine (Psychiatry & Neurology) Physician | — | — | — |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/12/2026
- **Last updated:** 09/10/2026