Healthcare Provider Details

I. General information

NPI: 1417268681
Provider Name (Legal Business Name): UCSF MEDICAL GROUP BUSINESS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

1635 DIVISADERO ST STE 625
SAN FRANCISCO CA
94143-1821
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-4003
  • Fax: 415-476-4150
Mailing address:
  • Phone: 415-476-4029
  • Fax: 415-476-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number220000091
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220000091
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number220000091
License Number StateCA

VIII. Authorized Official

Name: MR. DAVID REIN
Title or Position: CFO
Credential:
Phone: 415-476-4003