Healthcare Provider Details

I. General information

NPI: 1831491976
Provider Name (Legal Business Name): UCSF PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9263 N SAYBROOK DR APT 225
FRESNO CA
93720-0823
US

IV. Provider business mailing address

9263 N SAYBROOK DR APT 225
FRESNO CA
93720-0823
US

V. Phone/Fax

Practice location:
  • Phone: 559-289-7506
  • Fax:
Mailing address:
  • Phone: 559-289-7506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISS ANNA MARIE BOWSER
Title or Position: PEDIATRIC RESIDENT
Credential: M.D
Phone: 559-289-7506