Healthcare Provider Details

I. General information

NPI: 1356345789
Provider Name (Legal Business Name): PETER S UZELAC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S ELISEO DR STE 107 ATTN: JAIMIE VIGIL
GREENBRAE CA
94904-2017
US

IV. Provider business mailing address

1100 S ELISEO DR STE 107 ATTN: JAIMIE VIGIL
GREENBRAE CA
94904-2017
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-9404
  • Fax: 415-484-7045
Mailing address:
  • Phone: 415-925-9404
  • Fax: 415-484-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberA72448
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: