Healthcare Provider Details

I. General information

NPI: 1295747111
Provider Name (Legal Business Name): CALIFORNIA PACIFIC CARDIOVASCULAR MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WEBSTER ST SUITE 516
SAN FRANCISCO CA
94115-2373
US

IV. Provider business mailing address

2100 WEBSTER ST SUITE 516
SAN FRANCISCO CA
94115-2373
US

V. Phone/Fax

Practice location:
  • Phone: 415-923-3006
  • Fax:
Mailing address:
  • Phone: 415-923-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: BRUCE N. BRENT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 415-923-3006