Provider Demographics
NPI:1235926551
Name:DAVID, KHARISSA CHOENELLE
Entity type:Individual
Prefix:
First Name:KHARISSA CHOENELLE
Middle Name:
Last Name:DAVID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 GEARY ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-7228
Mailing Address - Country:US
Mailing Address - Phone:805-796-8145
Mailing Address - Fax:
Practice Address - Street 1:822 GEARY ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-7228
Practice Address - Country:US
Practice Address - Phone:805-796-8145
Practice Address - Fax:415-823-4255
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA748726164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse