Provider Demographics
NPI:1215955919
Name:SVIDLER, INESSA (MD)
Entity type:Individual
Prefix:
First Name:INESSA
Middle Name:
Last Name:SVIDLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2299 POST ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3473
Mailing Address - Country:US
Mailing Address - Phone:415-346-4199
Mailing Address - Fax:415-931-6718
Practice Address - Street 1:2320 SUTTER ST
Practice Address - Street 2:#203
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3038
Practice Address - Country:US
Practice Address - Phone:415-346-4199
Practice Address - Fax:415-931-6718
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA056364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A563640Medicare ID - Type Unspecified
CAG43823Medicare UPIN