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Individual

SUN CAPTAIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
3031 TELEGRAPH AVE STE 217, BERKELEY, CA 94705-2053
(510) 981-8222
(510) 981-8228
Mailing address
601 VAN NESS AVE APT 52, SAN FRANCISCO, CA 94102-3263
(415) 794-8441
(510) 981-8228

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA17206
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PA 17206
PA LICENSE
CA
Enumeration date
05/16/2012
Last updated
03/07/2023
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