Healthcare Provider Details

I. General information

NPI: 1356912661
Provider Name (Legal Business Name): UCSF MEDICAL GROUP BUSINESS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 REDWOOD SHORES PKWY
REDWOOD CITY CA
94065-1173
US

IV. Provider business mailing address

290 REDWOOD SHORES PKWY
REDWOOD CITY CA
94065-1173
US

V. Phone/Fax

Practice location:
  • Phone: 123-456-7891
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER DEARMAN
Title or Position: DIRECTOR
Credential:
Phone: 415-353-3236