Provider Demographics
NPI:1306692892
Name:MADDON, DAVID PAUL
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PAUL
Last Name:MADDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 SACRAMENTO ST APT 1007
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2265
Mailing Address - Country:US
Mailing Address - Phone:415-947-9609
Mailing Address - Fax:
Practice Address - Street 1:1202 MARINER DR UNIT C
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94130-1210
Practice Address - Country:US
Practice Address - Phone:415-947-9609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker