Provider Demographics
NPI:1538980669
Name:NIVET, MARK STEPHEN (ADMIN)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEPHEN
Last Name:NIVET
Suffix:
Gender:M
Credentials:ADMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 DUBOCE AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1250
Mailing Address - Country:US
Mailing Address - Phone:415-518-7038
Mailing Address - Fax:
Practice Address - Street 1:1380 HOWARD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2638
Practice Address - Country:US
Practice Address - Phone:415-552-6242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
CA174400000X376G00000X
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No376G00000XNursing Service Related ProvidersNursing Home Administrator