Healthcare Provider Details

I. General information

NPI: 1578927109
Provider Name (Legal Business Name): UNIVERSITY OF SAN FRANCISCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2016
Last Update Date: 04/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 FULTON ST
SAN FRANCISCO CA
94117-1080
US

IV. Provider business mailing address

5050 SPRING VALLEY RD
DALLAS TX
75244-3995
US

V. Phone/Fax

Practice location:
  • Phone: 415-422-6431
  • Fax: 972-367-3451
Mailing address:
  • Phone: 800-555-9073
  • Fax: 972-367-3452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MOUZON BASS III
Title or Position: AGEN
Credential:
Phone: 972-367-4845