Healthcare Provider Details

I. General information

NPI: 1508909466
Provider Name (Legal Business Name): CALIFORNIA PACIFIC SPECIALTY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 FILLMORE ST SUITE A
SAN FRANCISCO CA
94115-1813
US

IV. Provider business mailing address

2302 FILLMORE ST SUITE A
SAN FRANCISCO CA
94115-1813
US

V. Phone/Fax

Practice location:
  • Phone: 415-931-3313
  • Fax: 415-931-3003
Mailing address:
  • Phone: 415-931-3313
  • Fax: 415-931-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELE GANDOLFO
Title or Position: DIRECTOR OFFICER
Credential:
Phone: 415-931-3313