Healthcare Provider Details

I. General information

NPI: 1124404710
Provider Name (Legal Business Name): UCSF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 IRVING ST APT C
SAN FRANCISCO CA
94122-2207
US

IV. Provider business mailing address

930 IRVING ST APT C
SAN FRANCISCO CA
94122-2207
US

V. Phone/Fax

Practice location:
  • Phone: 206-313-3505
  • Fax:
Mailing address:
  • Phone: 206-313-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number64807
License Number StateCA

VIII. Authorized Official

Name: DR. SHEILA BREAR
Title or Position: DIRECTOR
Credential:
Phone: 415-514-2066