Individual
AZZEDINE ALAIA PUTRI TAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1049 HOWARD ST, SAN FRANCISCO, CA 94103-2822
(408) 782-4516
Mailing address
1049 HOWARD ST, SAN FRANCISCO, CA 94103-2822
(408) 782-4516
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
106H00000X
Marriage & Family Therapist
—
—
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
942335626
COMMUNITY FORWARD SF
—
Enumeration date
11/14/2023
Last updated
11/14/2023
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