Healthcare Provider Details

I. General information

NPI: 1407273279
Provider Name (Legal Business Name): UNIVERSITY OF THE PACIFIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 5TH ST POPL SUITE 407E
SAN FRANCISCO CA
94103-2919
US

IV. Provider business mailing address

155 5TH ST POPL SUITE 407E
SAN FRANCISCO CA
94103-2919
US

V. Phone/Fax

Practice location:
  • Phone: 415-929-6560
  • Fax: 415-929-6654
Mailing address:
  • Phone: 415-929-6560
  • Fax: 415-929-6654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. ED PEGUEROS
Title or Position: ASST DEAN, BUDGET & FIN ADMIN
Credential:
Phone: 415-351-7192