Healthcare Provider Details

I. General information

NPI: 1750580569
Provider Name (Legal Business Name): UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 MARKET ST COMMUNITY FOCUS, RM. 4B
SAN FRANCISCO CA
94103-1706
US

IV. Provider business mailing address

PO BOX 7464
SAN FRANCISCO CA
94120-7464
US

V. Phone/Fax

Practice location:
  • Phone: 415-597-8000
  • Fax: 415-597-8004
Mailing address:
  • Phone: 415-502-7648
  • Fax: 415-502-8175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: GRACE FERNANDEZ
Title or Position: DIRECTOR
Credential:
Phone: 415-206-8969