Healthcare Provider Details

I. General information

NPI: 1285012690
Provider Name (Legal Business Name): UCSF PEDIATRIC RHEUMATOLOGY DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 OHLONE AVE APT 788
ALBANY CA
94706-1967
US

IV. Provider business mailing address

755 OHLONE AVE APT 788
ALBANY CA
94706-1967
US

V. Phone/Fax

Practice location:
  • Phone: 510-502-0565
  • Fax:
Mailing address:
  • Phone: 510-502-0565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number2007457
License Number StateCA

VIII. Authorized Official

Name: DR. MERAV NA HESHIN-BEKENSTEIN
Title or Position: FELLOW
Credential: MD
Phone: 510-502-0565